Non-high-density lipoprotein and very-low-density lipoprotein cholesterol and their risk predictive values in coronary heart disease

To determine if non-high-density lipoprotein (HDL) cholesterol is a more useful predictor of coronary heart disease (CHD) risk than low-density lipoprotein (LDL) cholesterol and if very-low-density lipoprotein (VLDL) cholesterol is an independent predictor of CHD risk, data from the Framingham Heart Study (2,693 men, 3,101 women) were used for this analysis. All subjects were aged > or =30 years and free of CHD at baseline, and incident CHD was the end point (618 men, 372 women). Cox proportional-hazards models were used to assess the risk for CHD (relative risks and 95% confidence intervals) on the basis of the joint distribution of LDL cholesterol and non-HDL cholesterol (in milligrams per deciliter), as well as LDL cholesterol, non-HDL cholesterol, and VLDL cholesterol as continuous variables. After multivariate adjustment, within non-HDL cholesterol level, no association was found between LDL cholesterol and the risk for CHD, whereas within LDL cholesterol levels, a strong positive and graded association between non-HDL cholesterol and risk for CHD was observed. When the analysis was repeated within triglyceride levels (<200 vs > or =200 mg/dl), the risk pattern did not change significantly. Also, VLDL cholesterol was found to be a significant predictor of CHD risk after adjusting for LDL cholesterol at triglyceride levels of > or =200 or <200 mg/dl. In conclusion, these results suggest that non-HDL cholesterol level is a stronger predictor of CHD risk than LDL cholesterol; that is, VLDL cholesterol may play a critical role in the development of CHD.     

High-density lipoprotein cholesterol and coronary heart disease

There is a large body of evidence demonstrating an inverse correlation between circulating levels of high-density lipoprotein (HDL) cholesterol and cardiovascular disease risk. For every 1-mg/dL increase in HDL, it is estimated that the risk of cardiovascular events decreases by 2% to 3%. HDL is one of many factors that contribute to the regulation of the atherosclerotic process. HDL mediates reverse cholesterol transport and exhibits numerous beneficial properties, including antioxidant, antiinflammatory, and antithrombotic effects on the vasculature. Recent studies have expanded our understanding of the vasoprotective mechanisms of HDL to include enhanced nitric oxide production and improved endothelium-dependent relaxation. Progress has also been made in determining the molecular mechanisms that mediate reverse cholesterol transport. Recently published National Cholesterol Education Program Adult Treatment Panel guidelines have broadened the definition of low levels of HDL and encourage more aggressive screening and treatment of lipid abnormalities. Several therapeutic interventions can augment HDL concentrations, and there is increasing evidence that these interventions improve cardiovascular outcomes. Research focusing on defining the molecular roles of HDL will likely identify potential therapeutic targets for decreasing the incidence and progression of coronary heart disease. This review highlights the role of HDL in coronary heart disease, from basic mechanisms of action to recent clinical trial results.     

血清非高密度脂蛋白胆固醇对老年非吸烟人群冠心病发生及冠状动脉狭窄程度的影响

目的 探讨血清非高密度脂蛋白胆固醇(non-HDL-C)对老年非吸烟人群冠心病(CHD)发生及冠状动脉狭窄程度的影响。方法 选择2016年6月至2019年6月因胸痛于承德市中心医院入院,并行冠状动脉造影检查的360例≥65周岁的老年非吸烟患者为研究对象,根据是否发生冠心病将患者分为非CHD组(110例)与CHD组(250例)。根据冠状动脉狭窄程度积分(Gensini积分,轻度病变组、重度病变组)与病变累及冠状动脉支数(单支病变组、双支病变组、多支病变组),将250例CHD患者进一步分组,比较各组临床资料、生化指标及冠状动脉造影结果。采用SPSS 25.0统计软件进行数据分析。根据数据类型,分别采用t检验、方差分析、Mann-Whitney U检验或χ²检验进行组间比较。采用Spearman相关分析non-HDL-C与Gensini积分的相关性。采用logistic回归分析重度CHD的危险因素。通过受试者工作特征(ROC)曲线评价CHD的诊断效能。结果 CHD组的尿酸(UA)、脂蛋白-a(Lp-a)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C...     

胆红素与血脂的综合指数对冠心病诊断价值的探讨

目的 :探讨胆红素与血脂的综合指数对冠心病 (CHD)的诊断价值。方法 :将 15 4例行冠状动脉 (冠脉 )造影术者 ,按照冠脉造影结果分为 3组 :CHD高度狭窄组、中度狭窄组 ,冠脉正常组 ,分析组间血脂、胆红素及综合指数的差异及其对CHD的预测符合率。结果 :CHD组患者血清总胆红素 (TBil)明显低于冠脉正常组 (P <0 .0 1) ,血清总胆固醇 (TC)、低密度脂蛋白胆固醇 (LDL C) ,LDL C [高密度脂蛋白胆固醇 (HDL C) +TBil]比值、TC (HDL C +TBil)比值水平明显高于冠脉正常组 (P <0 .0 5或P <0 .0 1)。进行判别分析 ,将LDL C (HDL C +TBil)与传统危险因素 (HDL C、LDL C、TC、年龄、收缩压、血糖 )同时引入模型 ,年龄与LDL C (HDL C +TBil)进入模型 ,显示出较其他各项指标与CHD更强的相关性 ,且对CHD的预测符合率为 5 8.6 % ,高于传统危险因素对CHD预测符合率 (P <0 .0 5 )。结论 :胆红素与血脂的综合指数是有临床使用价值的预测指标     

非高密度脂蛋白胆固醇水平与中国人群心血管病发病危险的相关性

目的 探讨我国35～64岁人群血清非高密度脂蛋白胆固醇(non-HDL-C)水平与不同心血管病事件发病危险的相关性.方法 采用前瞻性队列研究方法 ,应用Cox比例风险模型对1992年建立的中国多省市心血管病危险因素队列中35～64岁基线无心血管疾病且资料完整的29 937名研究对象的基线non-HDL-C水平和12年间急性冠心病事件(AGE)、缺血性卒中、出血性卒中和缺血性心血管病事件(ICVD)的发病危险进行分析.结果 (1)多因素Cox回归分析显示,调整年龄、性别、吸烟、糖尿病、体质指数、收缩压等传统危险因素后,ACE、缺血性卒中及ICVD事件发病的相对危险均随non-HDL-C水平的升高而增加.以non-HDL-C＜3.37 mmol/L(130 mg/dl)为参照组,3.37～4.13 mmol/L(130～159 mg/dl)、4.14～4.91 mmol/L(160～189 mg/dl)和≥4.92 mmol/L(190 mg/dl)组ACE、缺血性卒中及ICVD事件发病相对危险分别为:1.24(0.91～1.70)、1.78(1.25～2.53)、2.23(1. 48～3.35);1.34(1.07～1.68)、1.38(1.04～1.83)、1.38(0.97～1.94)和1.37(1.12～1.63)、1.52(1.22～1.90)、1.70(1.30～2.22).而non-HDL-C≥4.92 mmol/L(190 mg/dl)时,出血性卒中发病危险明显下降.(2)对极低密度脂蛋白胆固醇(VLDL-C)和低密度脂蛋白胆固醇进行联合分析显示:VLDL-C与ACE的发病危险相关性最强,其次为ICVD事件.出血性卒中的危险随VLDL-C升高呈下降趋势.结论 non-HDL-C可增加ACE、缺血性卒中和ICVD事件的发病危险.VLDL-C对ICVD事件的发病也具有一定的作用,其中对ACE的作用最为明显.     

HDL cholesterol lipoprotein levels and the atherogenicity coefficient in males with diabetes mellitus and ischemic heart disease

A hundred males aged 40-69 years receiving treatment at the Institute of Experimental Endocrinology and Hormone Chemistry for type I and II diabetes mellitus were examined. Thirty-eight patients had coronary heart disease (CHD). The diagnosis of CHD was based on the data of the WHO Cardiological Questionnaire and the presence of ECG changes corresponding to the categories of the Minnesota Code 1-1,2,7; 4-1,2 and 5-1,2 (without 3-1,3). The blood levels of total cholesterol (CS), triglycerides (TG), high density lipoprotein cholesterol (HDLC) and the atherogenicity coefficient (AC) were determined in all patients. The results of the study showed that males with diabetes mellitus irrespective of its type or the presence of CHD had significantly higher mean values of total CS, TG and AC than in control. The mean levels of HDLC in males with type I diabetes mellitus without CHD did not differ from those in normal subjects whereas the level of HDLC in patients with type II diabetes mellitus was lowered. The patients with CHD showed a significant decrease in HDLC in both type I and II diabetes. The highest mean values of TG, AC and the lowest levels of HDLC were characteristic of the males with type II diabetes mellitus and CHD.     

Efficacy of raising high-density lipoprotein cholesterol for prevention of coronary heart disease

Conclusions Treatment decisions related to disease prevention are often based on related assumptions. An intervention-induced change in a surrogate marker (such as HDL cholesterol) in the desired direction translates into health benefits (such as reduction in coronary events). The VA-HIT showed that fibric acid therapy significantly reduced major cardiovascular events (cardiovascular death, myocardial infarction, and stroke) in patients with CHD by raising HDL cholesterol. However, the efficacy of the treatment may be also explained by lowering triglycerides. A low HDL cholesterol concentration and hypertriglyceridemia are frequently accompanied by the features of the metabolic syndrome found in impaired glucose tolerance and in individuals who are abdominally obese. New National Cholesterol Education Program Adult Treatment III guidelines emphasize the importance of metabolic syndrome and raise the cutoff level for defining abnormally low HDL, incorporate triglyceride levels into treatment strategies when they exceed 200 mg/dL, and recognize that in some patient populations treatment specifically designed to increase HDL levels is appropriate. In metabolic syndromes, highly atherogenic lipoproteins, such as remnant lipoproteins and small dense LDL, are also increased. Thus, treatment should focus on not only raising HDL cholesterol and lowering triglycerides, but also normalizing the total dyslipidemia, in order to raise the efficacy of the treatment for CHD prevention.     

Utility of non-high-density lipoprotein cholesterol in hemodialyzed patients

Non-high-density lipoprotein-cholesterol (HDL-C) is proposed as a strong predictor of cardiovascular disease (CVD). Measuring non-HDL-C, as total cholesterol minus HDL-C, is convenient for routine practice because, among other advantages, fasting is not required. There are limited data of non-HDL-C in end-stage renal disease patients. We applied non-HDL-C calculation to 50 chronic renal patients receiving maintenance hemodialysis (HD) and 20 healthy subjects, apart from measurement of low-density lipoprotein (LDL), very-low-density lipoprotein (VLDL) HDL, intermediate-density lipoprotein-cholesterol (IDL-C), apoprotein (apo) B, and triglycerides. HD patients presented higher plasma triglycerides and IDL-C and lower HDL-C than the control group, even after adjustment for age (P < .05). VLDL-C increased in HD patients (P < .001) while differences in non-HDL-C did not reach significance (P = .08). To detect which parameter constitutes a better marker of CVD risk among HD patients, a receiver-operating characteristic (ROC) analysis was performed considering HD patients in the highest risk group for CVD. In the ROC graphic, the plots of VLDL and IDL-C exhibited the greater observed accuracy and the best performance, while non-HDL-C showed a curve close to the 45 degrees line indicating that this parameter is a poor discriminator for evaluating CVD risk among HD patients. Non-HDL-C calculation, expressing all apo B-containing lipoproteins, may miss the significant contribution of each atherogenic lipoprotein, such as increase in IDL. This observation would not be in agreement with the currently proposed application of non-HDL-C a useful tool for risk assessment among HD patients.     

The predictive power of low-density lipoprotein cholesterol for coronary calcification

Background: Chronic elevation of low-density lipoprotein cholesterol is a major risk factor for developing atherosclerosis. The purpose of this study was to examine the correlation and predictive power of low-density lipoprotein cholesterol for calcified atheromatous disease as measured by electron beam computed tomography. Methods: Six-thousand and ninety-three subjects underwent electron beam computed tomography of their coronary arteries, serum lipid testing, body fat determination and assessment of health status by questionnaire. Predictive power of low-density lipoprotein cholesterol for calcified atherosclerotic plaque was determined by correlations and multivariate logistic regression. Results: The correlation between low-density lipoprotein cholesterol and calcified plaque score was very modest (r=0.055, P<0.001). There was a trend toward increasing calcified plaque with increasing levels of low-density lipoprotein cholesterol. Multivariate logistic regression revealed that low-density lipoprotein cholesterol is a modest but significant predictor of calcified coronary plaque. After adjusting for age, gender and high-density lipoprotein cholesterol, the risk of having any calcified plaque was 1.05-times higher for each 10 mg/dl increase in low-density lipoprotein cholesterol (P<0.001). Individuals with a low-density lipoprotein cholesterol level above 160 mg/dl had a 62% increase in odds for the presence of calcified plaque. Conclusions: Low-density lipoprotein cholesterol is weakly correlated with and predictive of calcified atherosclerotic plaque burden as measured by electron beam computed tomography. Higher levels of low-density lipoprotein cholesterol are associated with increased risk for the presence of calcified atheromas.     

非高密度脂蛋白胆固醇水平与冠心病病情的相关性分析

目的探讨非高密度脂蛋白胆固醇水平与冠心病患者病情的相关性。方法对522例行冠状动脉造影检查的患者进行回顾性分析,根据冠状动脉造影结果结合临床特点、心电图表现、心肌标志物结果分为非冠心病组、心绞痛组、心肌梗死组,平均年龄60.00±10.02岁。采用Gensini评分评估冠心病患者冠状动脉病变程度,收集所有患者临床资料,采集静脉血检测血脂指标并计算非高密度脂蛋白胆固醇值,分析非高密度脂蛋白胆固醇水平与冠心病病情的相关性。结果三组间的非高密度脂蛋白胆固醇水平、Gensini积分差异有统计学意义(P0.05);心绞痛组非高密度脂蛋白胆固醇水平与Gensini积分正相关(r=0.130,P=0.022),心肌梗死组非高密度脂蛋白胆固醇水平与Gensini积分正相关(r=0.213,P=0.048);多元无序Logistic回归分析显示,年龄、性别、非高密度脂蛋白胆固醇水平是影响冠心病病情的危险因素(P0.05)。结论非高密度脂蛋白胆固醇水平是影响冠心病患者病情的一项重要指标。     

低水平高密度脂蛋白——冠心病独立危险因素

许多临床资料、流行病学研究发现,高密度脂蛋白与冠心病事件的发生率呈负相关,且支持低水平高密度脂蛋白是冠心病的独立危险因素。低水平高密度脂蛋白患者经药物治疗可以明显减少冠心病事件的发生率。     

非高密度脂蛋白胆固醇用于评估及预测冠心病危险

目的研究“非高密度脂蛋白胆固醇”(nonHDLC)在冠心病危险评估中的作用,并比较它与低密度脂蛋白胆固醇(LDLC)对急性冠心病事件的预测价值。方法①冠心病组(男性450例)/对照组(465例)分析,比较nonHDLC与其他血脂数据在两组间差异的显著性(分别用t检验及logistic回归分析)。②对1007例男性老年干部15年随访资料,分析nonHDLC和LDLC对冠心病事件(包括死亡)发生的危险性(用Cox回归分析)。结果①冠心病组/对照组分析中不论单变量或多变量统计,都显示nonHDLC在两组间差异的显著性高于LDLC,后者又高于总胆固醇和甘油三酯。此外HDLC是极显著的冠心病负危险因素。②前瞻性研究中显示冠心病事件(包括急性心肌梗死与冠心病死亡,共183例)发病率随nonHDLC与LDLC水平的递增而上升,两者从合适水平上升16mmol/L(619mg/dl),实际发病率上升约10%,相对危险(RR)值上升约110,但RR上升幅度在nonHDLC组略大于LDLC,表示对冠心病事件的预测nonHDLC略优于LDLC。HDLC水平与冠心病发病率呈负相关,从低水平(<10mmol/L)上升至正常水平(10～16mmol/L),RR值下降至054。结论nonHDLC是一项简便实用的冠心病危险评估及急性冠心病事件(包括死亡)预测的有效指标。     

以非高密度脂蛋白胆固醇为靶标的联合降脂药物治疗急性冠脉综合征患者的疗效

目的 以血清非高密度脂蛋白胆固醇（non-high-density lipoprotein cholesterol,non-HDL-C）浓度为靶标,探讨阿托伐他汀和非诺贝特联合用药在急性冠脉综合征患者中的疗效和安全性.方法 选取200例急性冠脉综合征患者,网络随机分为他汀降脂组（n=100,阿托伐他汀20 mg/d）和联合降脂组（n=100,阿托伐他汀20 mg/d＋非诺贝特250 mg/d）,分别于治疗前及治疗后3个月、12个月、24个月检测两组血清血脂浓度和高敏C反应蛋白（high-sensitivity C reaction protein,hs-CRP）浓度,计算non-HDL-C变化率及达标率,并记录两组患者主要心血管事件发生情况.结果 联合降脂组血脂和hs-CRP浓度降低幅度明显优于他汀降脂组;达标率、斑块消退率、血清C反应蛋白浓度＜2 mg/L率明显高于对照组,差异有统计学意义（P＜0.05）.在预防非致死性心肌梗死、再次血运重建、缺血性卒中、不稳定型心绞痛的事件发生上,联合降脂组明显优于他汀降脂组,差异有统计学意义（P＜0.05）.但两组全因病死率、心脏性死亡事件发生率比较,差异无统计学意义（P＞0.05）.结论 对急性冠脉综合征患者予以阿托伐他汀联合非诺贝特的降脂治疗较单药治疗效果更显著,具有良好的耐受性和安全性.     

Age-dependent associations of smoking and drinking with non-high-density lipoprotein cholesterol

Serum high-density lipoprotein (HDL) cholesterol levels are influenced by habitual smoking and drinking. Non-HDL cholesterol is known to be a potent predictor of cardiovascular disease. However, it remains to be determined whether the associations of non-HDL cholesterol with smoking and drinking differ with age. The objectives of this study were to investigate relationships among smoking, drinking, and non-HDL cholesterol and to investigate interactions of age with smoking and drinking regarding serum non-HDL cholesterol levels. Subjects (54,020 Japanese men aged 20-69 years) were divided into drinkers and nondrinkers or into smokers and nonsmokers and were further divided into 5 age groups with 10-year intervals. Subjects in each age group were divided into 3 subgroups according to alcohol or cigarette consumption. The mean levels of serum non-HDL cholesterol calculated after adjustment for age and body mass index were compared among the groups. In nondrinkers, non-HDL cholesterol levels of subjects in their 40s or older were significantly higher in heavy smokers than in nonsmokers, whereas non-HDL cholesterol levels of subjects in their 20s and 30s were not significantly different among non-, light, and heavy smokers. In drinkers, non-HDL cholesterol levels of subjects in all age groups were not higher in light and heavy smokers than in nonsmokers. In nonsmokers, non-HDL cholesterol in subjects in their 30s or older was significantly lower in light and heavy drinkers than in nondrinkers, whereas this difference was not observed in subjects in their 20s. In smokers, non-HDL cholesterol levels of subjects in all age groups were significantly lower in light and heavy drinkers than in nondrinkers, and the differences in non-HDL cholesterol between drinkers and nondrinkers tended to increase with advance of age. The difference in non-HDL cholesterol between drinkers and nondrinkers tended to be greater in smokers than in nonsmokers. Thus, the associations of non-HDL cholesterol with smoking and drinking were modified by drinking and smoking, respectively. Smoking is associated with high non-HDL cholesterol in nondrinkers, and drinking is associated with low non-HDL cholesterol in nonsmokers; these associations are shown at middle and elderly ages but not at young ages.