高密度脂蛋白胆固醇与心脑血管病相关性前瞻研究

目的 探讨我国35～64岁人群血清HDL-C水平与急性冠心病事件和急性卒中事件发病危险的关系.方法 采用前瞻性队列研究的方法 ,对11省市35～64岁队列人群共30 384人基线HDL-C水平和1992-2003年发生的急性冠心病和急性卒中事件关系进行分析.应用Cox比例风险模型对HDL-C水平与心血管病发病危险进行多因素分析.结果 (1)与对照组相比,随着HDL-C水平的降低,缺血性心血管病(ICVD)事件发病危险呈持续增加.(2)HDL-C水平与不同类型的心血管病发病危险的关系有所差别,随着HDL-C水平的降低,急性冠心病事件发病危险及缺血性卒中事件发病危险明显上升;而出血性卒中事件与HDL-C水平的关系差异无统计学意义.低HDL-C血症组急性冠心病发病的危险增加45%(RR=1.45,P＜0.05),缺血性卒中发病的危险增加53%(RR=1.53,P＜0.01).(3)在缺血性心血管病事件中,6.4%可归因于HDL-C水平降低;其中6.2%的急性冠心病事件和7.3%的急性缺血性卒中事件可归因于低HDL-C血症.结论 从HDL-C≥1.56mmol/L开始,随着HDL-C水平的降低,ICVD的发病危险明显上升.在血脂异常的防治中,对于低HDL-C应予以足够重视.

A prospective study of serum high density lipoprotein cholesterol, cardiovascular and cardiovascular risk in a Chinese muti-provinces cohort

Objective To evaluate the association between serum HDL-C and the risk of cardiovascular diseases(CHD) in subjects aged 35-64 years. Methods A prospective study was carried out in 11 provinces from 1992 to 2002. The association of baseline HDL-C level and cardiovascular disease occurrence was analyzed in 30384 subjects aged 35-64 years using Cox multivariate proportional hazards regression. Results (1) Compared with the group of HDL-C≥1.56 mmol/L, multivariate-adjusted relative risk of ischemic cardiovascular disease(ICVD), including CHD and ischemic stroke increased continuously with decreased HDL-C level. (2)HDL-C level had different impact on different types of CVD.Positive association was observed between HDL-C level and the risk of ischemic stroke,but the relationship between HDL-C level and the risk of hemorrhagic stroke was indefinite. Compared with the group with HDL-C≥1.56 mmol/L,the risk of CHD of the group with HDL-C≤1.03 mmol/L increased by 45%(RR=1.45,P＜0.05)and that of ischemic stroke increased by 53%(RR=1.53,P＜0.01).(3)6.4% of ICVD,7.2% of the acute CHD and 7.3% of the acute stroke was attributable to low serum high density lipoprotein cholesterol. Conclusions Starting from HDL-C≥1.56 mmol/L, the risk of ICVD increasescontinuously with decreased HDL-C level. Comprehensive intervention for multiple risk factor clustering should be strengthened to reduce theoverall risk of CVD.