血脂和脂蛋白水平对我国中年人群缺血性心血管病事件的预测作用

The predictive effects of lipids and lipoproteins on the incidence of ischemic cardiovascular disease in middle aged Chinese population

目的 评价不同血脂指标对我国中年人群缺血性心血管病事件的预测作用。方法采用前瞻性队列研究方法,在中美心肺疾病流行病学合作研究4组队列人群(北京和广州两地工人和农民)中选择35～59岁,基线无心肌梗死和脑卒中病史且主要资料完整者10 222人为研究对象(男性4963人,女性5259人),平均随访15.9年。观察终点为缺血性心血管病事件(ICVD),包括冠心病和(或)缺血性脑卒中。结果 随访期间发生ICVD事件378例,其中单纯冠心病96例,缺血性脑卒中270例,冠心病合并缺血性脑卒中12例。多因素Cox回归分析表明,控制年龄、性别以及收缩压(SBP)、糖尿病和吸烟等主要心血管病危险因素后,血清总胆固醇(TC)5.17～5.67 mmol/L组,5.68-6.19 mmol/L组,≥6.20 mmoL/L组ICVD事件发病相对危险性分别为1.34(1.00-1.80),1.61(1.15～2.26)和1.70(1.21～2.37);低密度脂蛋白胆固醇(LDL-C)3.62-4.12 mmol/L组,≥4.13 mmol/L组相对危险性分别为1.62(1.15～2.27)和1.67(1.17～2.40),均显著高于参照组(TC<5.17 mmoL/L,LDL-C<3.10 mmoL/L)。按照我国血脂异常防治建议提出的诊断标准,在TC临界升高以上(≥5.17 mmol/L)和升高(≥5.68 mmol/L)组,ICVD发病的归因危险度百分比(ARP)为33.8％和35.9％,人群归因危险度百分比(PARP)为10.6％和6.2％。

Objective The prospective evidence on the associations of cardiovascular diseases with dyslipidemia was still rear in China. The purpose of the current study is to evaluate the predictive effect of serum lipids and lipoproteins on the incidence of ischemic cardiovascular disease (ICVD) in middle aged Chinese population. Methods This prospective study is based on the PRC-USA Collaborative Study on Cardiovascular and Cardiopulmonary Epidemiology. A total of 10 222 individuals (4963 men and 5259 women) , aged 35-59, were selected from 4 cohorts, in Beijing and Guangzhou, urban and rural. The follow up period was 15. 9 years in average. The endpoint were events of ischemic cardiovascular disease (ICVD) , including coronary heart disease (CHD) and ischemic stroke. During the follow up period, 378 ICVD cases were diagnosed, 96 with CHD, 270 with ischemic stroke and 12 with both CHD and ischemic stroke. Results The result of multivariate Cox regression analyses indicated that with adjusting for age, sex, SBP, diabetes and smoking, the relative risk for ICVD incidence was 1. 34( 1. 00-1. 80) , 1. 61 ( 1. 15-2. 26) and 1. 70. (1. 21-2. 37) in TC 5. 17-5. 67 mmol/L, 5. 68-6. 19 mmol/L, and ≥6. 20 mmol/L respectively and was 1.62(1. 15-2. 27) ,1.67(1. 17-2.40) in LDL-C 3.62- 4. 12 mmol/L,≥4. 13 mmol/L respectively, which were significantly higher than their reference group (TC < 5. 17 mmol/L, LDL-C <3. 10 mmol/L). With the diagnostic criteria in the suggestion for Prevention and Treatment of Dyslipidemia in China, attributable risk proportion ( ARP) was 33. 8% and 35. 9% , population attributable risk proportion (PARP) was 10. 6% and 6. 2% for TC≥5. 17 mmol/L and ≥5. 68 mmol/L respectively, and the similar values were observed for LDL-C≥ 3. 10 mmol/L and LDL-C ≥ 3. 62 mmo/L. Independent predictive effect was also observed in elevated non-HDL-C as well as in TC/HDL-C. The incidence of ICVD was positively related to serum TG and inversely to HDL-C in this cohort, but the association was not statistically significant. Conclusion Although the level of serum lipids and lipoproteins was relatively low in Chinese middle aged populations compared to that in the westerner, the independent predictive effect on ICVD was confirmed for elevated TC, LDL-C, non-HDL-C, TC/HDL-C; if serum lipids was controlled in desirable level, the incident of ICVD in the population will decline about 10%.