脑血管病患者血氧化修饰低密度脂蛋白与脂质,脂蛋白及载脂…

用ＥＬＩＳＡ法测定了７１例脑血管病（ＣＶＤ）患者血浆氧化修饰低密度脂蛋白（ＯＭＬＤＬ）浓度，对比分析了患者血ＯＭＬＤＬ、甘油三酯（ＴＧ）、总胆固醇（ＴＣ）、高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）、低密度脂蛋白胆固醇ＬＤＬ－Ｃ、载脂蛋白Ａ－Ｉ（ａｐｏＡ－Ｉ）、ａｐｏＢ１００的浓度、变化及异常率，并分析了ＯＭＬＤＬＩ浓度与其它指的相关性。结果：ＣＶＤ患者血ＯＭＬＤＬ浓度显著高于对照组，ＬＤＬ－Ｃ浓度显著升高     

非诺贝特治疗高脂血症40例疗效观察

目的：观察非诺贝特对高脂血症的疗效。方法：对４０例高脂血症患者使用非诺贝特，每日３００ｍｇ，疗程６个月；治疗前后检测血清总胆固醇（ＴＣ）、甘油三酯（ＴＧ）、低密度脂蛋白胆固醇（ＬＤＬＣ）、高密度脂蛋白胆固醇（ＨＤＬＣ）和载脂蛋白Ａ１（ａｐｏＡ１）、载脂蛋白Ｂ（ａｐｏＢ）等。结果：ＴＧ平均降低了４５．２％，ＴＣ平均降低了２０．５％，ＨＤＬＣ平均上升了１５．４％，ＬＤＬＣ平均降低了２５．５％，ａｐｏＡ１平均上升了２．０％，ａｐｏＢ平均下降了３０．０％。结论：非诺贝特具有降低ＴＧ、ＴＣ、ＬＤＬＣ、ａｐｏＢ和升高ＨＤＬＣ、ａｐｏＡ１作用，从而可减少冠状动脉粥样硬化性心脏病的发病率和病死率     

血脂正常的冠心病患者血清载脂蛋白AⅠ、B_（100）检测的临床意义

目的探讨血脂正常的冠心病患者血清载脂蛋白水平及其检测的临床意义。方法检测３９例血清总胆固醇（ＴＣ）及甘油三酯（ＴＧ）均正常的冠心病患者血脂、脂蛋白及载脂蛋白（ａｐｏ）ＡＩ、Ｂ１００水平，并与４１例健康人作了比较。组内差别用ｔ检验，相关性比较用直线回归分析。结果ＨＤＬ－Ｃ、ａｐｏＡｌ含量及ａｐｏＡＩ／ａｐｏＢ１００比值显著低于健康人，差异显著至极显著（Ｐ＜０．０５～ｐ＜０．００１），ａｐｏＢ１００显著高于健康人，差异显著（Ｐ＜０．０５）。冠心病患者ＴＣ、ＴＧ及ＬＤＬ－Ｃ与ａｐｏＢ１００存在密切正相关。结论血清３ｐｏＢ１００含量升高、ａｐｏＡＩ含量及ａｐｏＡＩ／ａｐｏＢ１００比值降低是预测冠心病危险的最敏感、最准确的指标之一，特别是对血脂正常、无动脉硬化体征的冠心病患者。     

单纯性肥胖症脂蛋白（a）测定及其临床意义

测定１４４例单纯性肥胖症患者（ＳＯ）的脂蛋白（ａ）［ＬＰ（ａ）］及载脂蛋白Ａ１、Ｂ（ＡＰＯＡ１、ＡＰＯＢ）、总胆固醇（ＴＣ）、甘油三酯（ＴＧ）、高密度脂蛋白胆固醇（ＨＤＬＣ），并计算其ＨＤＬＣ与ＴＣ之比值（Ｈ／Ｃ）。ＬＰ（ａ）的ＳＯ全组与９２例正常对照组比较明显增高（Ｐ＜０．０１），每１０岁分一组与相应的对照组比较，３０岁以上各组增高（Ｐ＜０．０５）。其他脂质的ＳＯ各分组对应比较，ＡＰＯＢ、ＴＧ、ＴＣ较对照组增高，ＡＰＯＡ１、ＨＤＬＣ、Ｈ／Ｃ０降低（Ｐ＜０．０１）。ＬＰ（ａ）的增高及各脂类的异常是动脉粥样硬化及心、脑血管病变的危险因素。强调对ＳＯ早期防治十分重要。     

不同的透析膜对维持性血液透析患者血脂和脂蛋白代谢的影响及意义

目的：探讨不同的透析膜对维持性血液透析患者血脂和脂蛋白代谢的影响及临床意义。方法：分别检测２０例长期应用铜仿膜透析与２５例聚砜膜透析患者血清总胆固醇（ＴＣ）、甘油三酯（ＴＧ）、高密度胆固醇脂蛋白（ＨＤＬ）、低密度脂蛋白（ＬＤＬ）和极低密度脂蛋白（ＶＬＤＬ）、载脂蛋白（ａｐｏ）,包括ａｐｏＡ１、ａｐｏＢ及脂蛋白ａ（Ｌｐ（ａ））水平。结果：与对照组相比,铜仿膜透析组和聚砜膜透析组血清ＴＧ、ＴＣ、ａｐｏＢ、Ｌｐ（ａ）及ＴＧ／ＨＤＬ水平均明显增加,ＨＤＬ水平明显降低;与铜仿膜透析组相比,聚砜膜透析组血清ＨＤＬ及ａｐｏＡ１水平明显增加,其余指标则没有明显改变。另外,聚砜膜透析组ＨＤＬ水平及ＴＣ／ＨＤＬ比值达致动脉硬化水平的百分比与铜仿膜透析组相比明显降低。结论：长期应用聚砜膜透析可改善透析患者部分血脂代谢指标,其确切机制尚有待进一步研究。     

不同程度冠脉狭窄时血脂,载脂蛋白及纤维蛋白原与红细胞变形性…

按冠脉主要分支最大狭窄程度不同将冠心病（ＣＨＤ）分为明显狭窄组（ＯＳ）和轻度狭且（ＭＳ），探讨血脂（ＣＨ，ＴＧ，ＨＤＬ－ｃｈ），载脂蛋白（ａｐｏＡ１，ａｂｏＢ）及纤维蛋白原（Ｆｇ）对红细胞流变特性的作用。结果显示：ＣＨＤ两组的红细胞集率升高与Ｆｇ相关，ＴＧ可能是影响红细胞变形指数（ＤＩ）重要因素之一。随冠脉狭窄程度加重，ＨＤＬ－ｃｈ，ａｐｏＡ１，ａｐｏＢ对红细胞流变特性的影响也发生变化。     

急性出血性脑血管病并发多脏器功能失常综合征患者血浆内皮素-1及降钙素基因相关肽水平的观察

目的：探讨血浆内皮素１（ＥＴ１）和降钙素基因相关肽（ＣＧＲＰ）在急性出血性脑血管病（ＡＨＣＶＤ）并发多脏器功能失常综合征（ＭＯＤＳ）发病中的作用。方法：采用放射免疫法分别测定２１例ＡＨＣＶＤ合并ＭＯＤＳ患者（ＭＯＤＳ组）、２０例ＡＨＣＶＤ患者（ＡＨＣＶＤ组）及３０例正常人（正常对照组）血浆中ＥＴ１和ＣＧＲＰ水平。结果：ＭＯＤＳ组及ＡＨＣＶＤ组血浆ＥＴ１水平明显高于正常对照组（Ｐ均＜０．０１），ＭＯＤＳ组ＥＴ１水平又明显高于ＡＨＣＶＤ组（Ｐ＜０．０１）。ＡＨＣＶＤ组血浆ＣＧＲＰ水平高于正常对照组，但无显著性差异（Ｐ＞０．０５）。而ＭＯＤＳ组血浆ＣＧＲＰ水平明显低于正常对照组，ＥＴ１／ＣＧＲＰ（Ｅ／Ｃ）比值明显高于ＡＨＣＶＤ组及正常对照组（Ｐ均＜０．０１）。结论：血浆ＥＴ１水平升高、ＣＧＲＰ水平降低、Ｅ／Ｃ比值严重失衡与ＭＯＤＳ的发生相关；检测血浆ＥＴ１和ＣＧＲＰ水平对评估ＡＨＣＶＤ患者预后有一定意义     

不同的透析膜对维持性血液透析患者血脂和脂蛋白代谢的影响及 …

目的：探讨不同的透析膜对维持性血液透析患者血脂和脂蛋白代谢的影响及临床意义。方法：分别检测２０例长期应用铜仿膜透析与２５例聚砜膜透析患者血清总胆固醇（ＴＣ）、甘油三脂（ＴＧ）、高密度胆固醇脂蛋白（ＨＤＬ）、低密度脂蛋白（ＬＤＬ）和极低密度脂蛋白（ＶＬＤＬ）、载脂蛋白（ａｐｏ）,包括ａｐｏＡ１,ａｐｏＢ及脂蛋白ａ（Ｌｐ（ａ））水平。结果：与对照组相比,铜仿膜透析组和聚砜膜透析组血清ＴＧ,ａｐｏＢ、Ｌ     

66例老年冠心病患者脂蛋白分析

目的 探讨老年冠心病（ＣＨＤ）患者的脂蛋白特点。方法 取健康老年组与ＣＨＤ组做对照，分别做血清十项指标检测。包括ＴＣ，ＴＧ用酶法测定，ＨＤＬ－Ｃ．ａｐｏＡ．Ｂ．ＣⅡＣⅢ．Ｅ及Ｌｐ（ａ）用免疫比浊法测定。ＬＤＬ－Ｃ依据公式计算。结果 健康老年组与ＣＨＤ组比较，ＴＣ．ＴＧ．ＨＤＬ－Ｃ．ＬＤＬ－Ｃ．ａｐｏＡ，ａｐｏＢ，Ｐ〈０．００１；ａｐｏＣⅡ，Ｐ〈０．０１。ＴＧ．ＴＣ分别与ａｐｏＣⅡ．ａｐｏＣⅢ极相关     

高血压病患者血脂,脂蛋白,载脂蛋白临床研究

目的：探讨高血压病（ＥＨ）患者脂质代谢状况。方法：采用山西医科大学血脂研究室建立的常规方法测定了５０例ＥＨ患者和４５例人血浆ＴＧ、ＴＣ、ＨＤＬ－Ｃ,同时,采用ＥＬＩＳＡ法测定了ａｐｏＡＩ、ａｐｏＢ１００含量。结果：ＥＨ患者ＴＧ、ＴＣ、ＬＤＬ－Ｃ及ａｐｏＢ１００均高于ＣＧ,ＨＤＬ－Ｃ及ａｐｏＡＩ显著低于ＣＧ,以脂蛋白和载脂蛋白变化明显,并且,随高血压病情进展,脂质紊乱加重。结论：ＥＨ本身存在脂质代谢     

血脂与动脉粥样硬化发展阶段的相关性

目的通过检测动脉粥样硬化(As)不同发展阶段的各种血脂相关指标,来探讨各种检测值与As各个发展阶段的相关性。方法随机选择健康体检者60例[As(-)组]、脑As无并发症患者24例[As(+)组]、As性脑梗死患者67例[As(++)组],酶化学法测定血清三酰甘油(TG)、总胆固醇(TC),直接法测定低密度脂蛋白胆固醇(LDLC)、高密度脂蛋白胆固醇(HDLC),免疫透射比浊法测定载脂蛋白A1(ApoA1)、载脂蛋白B100(ApoB100)、脂蛋白(a)[LP(a)],并对三组的检测值进行统计分析。结果As(+)组与As(-)组比较,TG、TC、LDLC、ApoB100、LP(a)、ApoB100/ApoA1增高(P<0.05),HDLC、ApoA1降低(P<0.05)。As(++)组与As(+)组比较,ApoB100、LP(a)、ApoB100/ApoA1增高(P<0.05)。As(++)组与As(-)组比较,ApoB100、LP(a)、ApoB100/ApoA1显著增高(P<0.01)。结论TG、TC、LDLC、HDLC、ApoA1、ApoB100、LP(a)、ApoB100/ApoA1水平与As的早期发展阶段相关,而且ApoB100、LP(a)、ApoB100/ApoA1水平与As的晚期发展阶段相关。     

急性心肌梗死患者血脂水平变化与中医辨证分型的临床研究

目的：分析急性心肌梗死(AMI)患者血脂水平变化与中医辨证分型的关系。方法：AMI患者110例和冠心病组(对照组)100例进行总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDLC)、低密度脂蛋白胆固醇(LDLC)水平的测定,并按中医辨证分4型：心脉瘀阻型、痰热扰心型、气阴两虚型、心阳虚脱型。结果：在AMI急性期TC>6.2 mmol/L占17.3％,4.6～6.2 mmol/L占38.2％;TG>2.2 mmol/L占12.7％,1.7～2.2 mmol/L占13.6%;HDLC<0.8 mmol/L占18.2％;LDLC>3.5 mmol/L占19.1％。且心脉瘀阻型及痰热扰心型2组TC及LDLC升高,而HDLC下降,与对照组比较有显著性差异。死亡15例患者中有7例HDLC降低,占46.7％。心阳虚脱型HDLC下降及LDLC升高与对照组比较有显著差异。结论：高脂血症与AMI发生率有关,在AMI急性期可出现高脂血症。心脉瘀阻型及痰热扰心型易出现TC、LDLC升高和HDLC降低,尤以LDLC及HDLC改变更为突出。HDLC降低是AMI死亡危险因子之一。     

他克莫司联合糖皮质激素治疗肾病综合征的疗效及对炎症因子的影响

[目的]探讨他克莫司联合糖皮质激素治疗肾病综合征(NS)患者的疗效及对炎症因子的影响.[方法]86例NS患者随机分为试验组及对照组各43例,两组患者均实施糖皮质激素治疗,试验组另给予他克莫司联合治疗,观察治疗前后两组血脂[甘油三酯(TG)、血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]、炎症因子[白细胞介素-1(IL-1)、IL-6、肿瘤坏死因子-α(TNF-α)]、肾功能[尿素氮(BUN)、血肌酐(SCr)、24 h尿蛋白定量]及药物不良反应.[结果]治疗前两组各指标相比较无明显差异(P＞0.05);治疗后两组TG、TC、LDL-C、IL-1、IL-6、TNF-α、BUN、SCr、24 h尿蛋白定量较治疗前明显降低,HDL-C明显升高,且治疗后试验组TG、TC、LDL-C、IL-1、IL-6、TNF-a、BUN、SCr、24 h尿蛋白定量较对照组降低明显,HDL-C升高明显,且差异均有显著性(P＜0.05).两组药物不良反应发生率相比较差异无显著性(P＞0.05).[结论]他克莫司联合糖皮质激素治疗NS可有效调节患者血脂,显著降低炎性因子表达水平,继而达到提高其肾功能的目的.     

非酒精性脂肪肝患者血清非高密度脂蛋白胆固醇水平检测分析

目的了解非酒精性脂肪肝患者血清非高密度脂蛋白胆固醇(non-HDL-C)代谢水平,评价其临床应用价值。方法通过对单位体检者的影像学检查及肝功能、血糖、血脂等血清生化指标检测,并对其中非酒精性脂肪肝与体检健康者(对照组)进行比较。结果脂肪肝总检出率为9.15%,男性检出率12.50%,显著高于女性的5.99%(P<0.05);男性患者丙氨酸转氨酶(ALT)、间接胆红素(IBil)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A1(apoA1)、non-HDL-C、apoB100/apoA1、LDL-C/HDL-C、apoB100/HDL-C、总胆固醇/高密度脂蛋白胆固醇(TC/HDL-C)等与对照组比较差异具有统计学意义(P<0.05或P<0.01),女性患者天冬氨酸转氨酶(AST)、总胆红素(TBil)、直接胆红素(DBil)I、Bil、葡萄糖(Glu)、TC、TG、LDL-C、apoA1、non-HDL-C、apoB100/apoA1、LDL-C/HDL-C、apoB100/HDL-C、TC/HDL-C与对照组比较差异具有统计学意义(P<0.05或P<0.01);non-HDL-C与TC、LDL-C、TG、HDL-C、apoA1、apoB100、apoB100/apoA1、TC/HDL均显著相关(r=0.411~0.989,P<0.01)。结论非酒精性脂肪肝普遍具有脂类代谢异常和肝脏受损特点,non-HDL-C的检测有助于全面了解非酒精性脂肪肝脂类代谢状况。     

不同年龄多囊卵巢综合征患者性激素结合球蛋白与激素指标、血脂指标的相关性

目的分年龄阶段探讨多囊卵巢综合征(PCOS)患者血清性激素结合球蛋白(SHBG)与空腹胰岛素(FINS)、硫酸脱氢表雄酮(DHEA-S)及血脂指标的相关性。方法回顾性分析2017年1月1日至2019年8月30日在山东大学生殖医学研究中心就诊的3349例PCOS患者的FINS、性激素和血脂指标,按照SHBG的参考值下限(32.4 nmol/L)分为SHBG低值组(SHBG<32.4 nmol/L,n=1780)和SHBG高值组(SHBG≥32.4 nmol/L,n=1569),并且分别对每组进行年龄分层(<25岁、25~<30岁、30~<35岁、≥35岁)研究,分析其血清SHBG、FINS、DHEA-S及血脂指标特征。结果在<25岁、25~<30岁、30~<35岁几个年龄阶段PCOS患者中,SHBG低值组患者FINS、DHEA-S水平明显高于SHBG高值组患者,差异有统计学意义(P<0.05);且随着年龄的增长,SHBG低值组中FINS及两组中DHEA-S呈现递减趋势(P<0.05)。在<25岁、25~<30岁、30~<35岁几个年龄阶段PCOS患者中,SHBG低值组患者总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDLC)水平明显高于SHBG高值组患者,差异有统计学意义(P<0.05);SHBG低值组患者高密度脂蛋白胆固醇(HDLC)水平明显低于SHBG高值组患者,差异有统计学意义(P<0.05);且两组TC、TG、LDLC随着年龄的增长呈现递增趋势(P<0.05)。<25岁、25~<30岁和30~<35岁PCOS患者血清SHBG水平与HDLC呈正相关(P<0.05),而与FINS、DHEA-S、TC、TG、LDLC呈负相关(P<0.05)。结论PCOS患者SHBG与FINS、DHEA-S及血脂指标关系密切,SHBG水平的变化也可以作为FINS、DHEA-S和血脂变化的提示指标,为临床提早诊断及及时治疗PCOS提供重要的参考依据。     

老年女性动脉粥样硬化性血栓性脑梗死患者性激素及血脂变化的研究

目的：研究老年女性动脉粥样硬化性血栓性脑梗死（ＡＴＣＩ）患者体内性激素与血脂的变化规律。方法：测定４６例老年女性ＡＴＣＩ患者（Ａ组）、４３例老年健康女性（Ｂ组）和４１例正常育龄行经的年轻健康女性（Ｃ组）的血清雌二醇（Ｅ２）、促卵泡刺激素（ＦＳＨ）和促黄体生成素（ＬＨ）;同时测定了血浆总胆固醇（ＴＣ）、甘油三酯（ＴＧ）、低密度脂蛋白胆固醇（ＬＤＬＣ）及高密度脂蛋白胆固醇（ＨＤＬＣ）。结果：Ａ组与Ｂ组、Ｃ组比较显示,Ｅ２、ＨＤＬＣ水平显著降低,ＦＳＨ、ＬＨ、ＴＣ、ＴＧ和ＬＤＬＣ水平则显著增高（Ｐ均＜０．０１）。线性相关分析,Ｅ２与ＦＳＨ、ＬＨ、ＴＣ、ＴＧ、ＬＤＬＣ水平呈显著负相关,而与ＨＤＬＣ水平呈显著正相关。结论：老年女性ＡＴＣＩ患者存在着严重的性激素失调及脂代谢异常,可能为老年女性ＡＴＣＩ患者发病的原因之一     

血液透析患者低密度脂蛋白受体Taq I位点基因多态性与血脂水平检测

目的 探讨血液透析患者脂代谢紊乱的临床特征及低密度脂蛋白受体(LDLR)基因多态性对脂代谢的影响。方法 生化方法检测血液透析血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDLC)、低密度脂蛋白胆固醇(LDLC)、载脂蛋白(Apo A1、ApoB、ApoE)及脂蛋白[Lp(a)]水平，多聚合酶链反应-限制性片断长度(PCR—RFLP)方法检测LDLR内含子4Taq I位点基因多态性。结果 血液透析患者脂代谢紊乱主要表现为血清，TG水平显著增高，HDLC水平显著降低。33％的患者血清TG水平高于正常水平，10．4％的患者HDLC低于正常水平。偏相关回归分析显示，TG水平与血清ALB水平、透析时体外循环血流量显著相关；HDLC与KT／V显著相关。血液透析患者高血压的发生率为73．6％，心血管疾病为25％。伴心血管疾病组TG水平显著高于无心血管疾病组，伴高血压组与无高血压组血脂水平无显著差异。LDLR基因多态性检测结果显示，血液透析组与对照组间LDLR内含子4Taq I位点基因型与等位基因分布频率无显著差异。LDLR基因多态性对血脂水平的影响表现为LDLR内含子4Taq I位点基因型-／-的血液透析患者甘油三酯水平较高。结论 血液透析患者脂代谢紊乱主要表现为血清TG、ApoB水平显著增高，HDLC等指标显著降低。伴心血管并发症的患者，TG水平显著高于无并发症的患者。，TG水平与血清ALB水平、透析时体外循环血流量显著相关；HDLC与KT／V显著相关。LDLR内含子4Taq I位点基因型-／-血液透析患者易发生血清甘油三酯水平增高。     

Low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol and apolipoprotein B: relationships among the different measurements

Serum low-density lipoprotein cholesterol (LDLC) value is a recognized target for atherosclerotic risk management, and is generally calculated using the "Friedewald formula". Alternative risk markers include directly measured LDLC, non-high-density lipoprotein cholesterol (non-HDLC) and apolipoprotein B (ApoB). The relationships among such various measured or calculated quantities in medium-sized sets of patient results were investigated. Results from two sets of patients were retrieved from our laboratory information systems. One group (n=8436) included results of cholesterol, HDLC, triglyceride (TG) and glucose measurements. A second group (n = 902) included, in addition, results of ApoB measurement. The results confirmed the unreliability of the Friedewald formula at TG >350 mg/dL (3.96 mmol/L), but also indicated TG-linked underestimation of LDLC below such a TG level. By contrast, non-HDLC values were shown to be independent of TG, and better correlated to ApoB than LDLC values. Mathematically, the difference between non-HDLC and LDLC is TG x 0.458 (values in mmol/L): therefore, the latter cannot be compared to (or converted into) the former by simply adding a constant amount. The ratio LDLC/ApoB was shown continuously to decrease with increasing TG concentrations, while the ratio non-HDLC/ApoB did not. The TG-dependent underestimation of LDLC may be the reason for the reported better cardiovascular risk predictivity of non-HDLC in diseases associated with TG increase, such as in diabetes. Non-HDLC values are not influenced by TG levels, and are better correlated with ApoB.     

Comparison of various lipid variables as predictors of coronary heart disease in Japanese men and women with type 2 diabetes: subanalysis of the Japan Diabetes Complications Study

OBJECTIVE

To determine the best lipid variable to predict coronary heart disease (CHD) in Japanese patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS

Eligible Japanese men and women (1,771) aged 40–70 years with type 2 diabetes from 59 institutes nationwide were followed for a planned 8-year period. The performance of eight conventional lipid variables, i.e., total cholesterol (TC), LDL-cholesterol (LDLC), HDL-cholesterol (HDLC), triglycerides (TGs), non-HDLC, TC/HDLC ratio, LDLC/HDLC ratio, and TG/HDLC ratio, as predictors of incident CHD were evaluated by four methods: hazard ratio (HR) per one SD increment by multivariate Cox analysis, χ² likelihood ratio test, area under the receiver operating characteristic curve (AUC), and tertile analysis.

RESULTS

Although all variables significantly predicted CHD events in men, non-HDLC (HR per one SD 1.78 [95% CI 1.43–2.21]; AUC 0.726) and TC/HDLC (HR 1.63 [1.36–1.95]; AUC 0.718) had the better predictive performances among the variables, including LDLC. In women, TGs (log-transformed; HR 1.72 [1.21–2.43]; AUC 0.708) were the best predictor according to results of tertile analysis (HR of the top tertile versus the bottom tertile 4.31 [1.53–12.16]). The associations with incident CHD were linear and continuous.

CONCLUSIONS

For Japanese diabetic men, non-HDLC and TC/HDLC were the best predictors, whereas TGs were most predictive for women. These findings, which included prominent sex differences, should be considered among clinical approaches to risk reduction among East Asians with diabetes.Type 2 diabetes is characterized by an excessive incidence of coronary heart disease (CHD), and serum lipid values are among the strongest predictors of CHD (1,2). Although serum LDL-cholesterol (LDLC) has been conventionally used as a therapeutic marker and/or target in many guidelines based on trials using statins (1,2), characteristic features of diabetic dyslipidemia, which are closely associated with insulin resistance, are elevated levels of triglycerides (TGs) and small, dense LDLC (independent of LDLC level) as well as decreased levels of HDL-cholesterol (HDLC) (1,2). The use of LDLC alone for assessment of cardiovascular risk would ignore these TG-rich lipoproteins (TRLs, i.e., VLDL and intermediate-density lipoprotein) and low HDLC, all of which affect the risk of a CHD event independently of LDLC (1–4). Moreover, LDLC values, as estimated by the Friedewald formula, become progressively less accurate as the TG level increases.Based on this background, it has been established that other lipid parameters, typically non-HDLC (determined by subtracting the HDLC concentration from the total cholesterol [TC] concentration in plasma) or apolipoprotein B (apoB), both of which reflect TRLs and small, dense LDLC, can be considered better predictors of CHD than LDLC and have been introduced into some guidelines as a secondary target for therapy (5–7). Furthermore, the ratios of TC to HDLC (TC/HDLC), which has clinical significance equivalent to non-HDLC/HDLC, LDLC to HDLC (LDLC/HDLC), and TGs to HDLC (TG/HDLC) are also used for assessing cardiovascular risk (3,4). It should be mentioned that non-HDL/HDL is always one unit lower than TC/HDLC.Despite these considerations, these fundamental lipid measures (TC, HDLC, and TGs) and their calculated indices (LDLC, non-HDLC, TC/HDLC, LDLC/HDLC, and TG/HDLC) have not been completely and directly compared as predictors of CHD by multiple analytical methods in past prospective studies in diabetic subjects (8–19). Results obtained have been inconsistent, and only one study (19) analyzed men and women separately. Therefore, whether LDLC performs better than the other indices or, if not, which variable is the best predictor of a CHD event has not been fully determined in diabetic subjects. Furthermore, all previous examinations of the performance of lipid variables as predictors of CHD in diabetic subjects (8–19) were performed in Western countries or in Caucasians. It is uncertain whether their results can be extrapolated to East Asian diabetic subjects, who have substantially different profiles regarding CHD and its risk factors, including a much lower incidence of CHD and degree of obesity (20–22).In this analysis of data from a long-term follow-up of Japanese patients with type 2 diabetes, we compared eight conventional lipid variables, all of which are routinely measured or can be easily calculated in clinical care settings, as predictors of CHD events. To directly and quantitatively compare variables having different average values as well as variations in quantities and ratios, we used four different analytical methods to determine the best predictor of CHD. These were the multivariate-adjusted hazard ratio (HR) per one SD increment in the Cox hazard model, χ² likelihood ratio test, area under the receiver operating characteristic (ROC) curve (AUC), and tertile analysis.