携带载脂蛋白E的HDL-C与冠心病发病风险的前瞻性队列研究

Association between apolipoprotein E-containing HDL-C and coronary heart disease risk:a community-based cohort study

目的探讨我国人群携带载脂蛋白E的HDL-C(APOE-HDL-C)与冠心病发病风险的关系。方法选择中国多省市心血管病队列研究中参加2002年或2007年心血管病危险因素调查并随访至2013年12月31日的研究对象5417人(排除基线有心血管病者)。检测研究对象基线APOE-HDL-C和总HDL-C水平。计算APOE-HDL-C/总HDL-C比值。采用Cox比例风险模型分析HDL-C相关指标与冠心病发病风险的关系。结果研究对象平均随访6.8年,发生急性冠心病事件100例。调整潜在混杂因素后,基线HDL-C相关指标与冠心病发病风险显著负相关。与APOE-HDL-C/总HDL-C比值最低四分位组相比,最高四分位组的急性冠心病事件发病相对风险降低74%(HR=0.26,95%CI:0.12~0.71)。APOE-HDL-C/总HDL-C比值最高分位组的个体冠心病预测发病绝对风险最低[0.48%(0.44%~0.52%)],显著低于HDL-C最高分位组个体冠心病预测发病绝对风险[0.83%(0.78%~0.88%)]。结论基线APOE-HDL-C/总HDL-C比值与急性冠心病事件发病风险显著负相关。APOE-HDL-C/总HDL-C比值升高者的冠心病预测发病绝对风险显著低于总HDL-C升高者。研究结果提示APOE-HDL-C可作为反映HDL抗动脉粥样硬化功能的新生物标志物。

Objective To assess whether apolipoprotein E-containing HDL-C(APOE-HDL-C)is causally associated with coronary heart disease(CHD)risk.Methods In total,5417 cardiovascular disease-free participants at baseline were followed up for up to 10 years in the Chinese Multi-provincial Cohort Study.APOE-HDL-C and HDL-C were measured in all participants.APOE-HDL-C/total HDL-C ratio was calculated.Multivariate Cox regression was employed to assess the association between HDL-C related biomarkers and 10-year CHD incident risk.Results A total of 100 incident CHD events occurred during a mean 6.8 years follow-up.High levels of baseline HDL-C related biomarkers were significantly negatively associated with incident CHD risk.Comparison with participant with lowest level of APOE-HDL-C/total HDL-C ratio,those with highest level of APOE-HDL-C/total HDL-C ratio had 74%decreased risk of CHD(HR=0.26,95%CI:0.12-0.71).The individual with the highest level of APOE-HDL-C/total HDL-C ratio had the lowest absolute risk[0.48%(0.44%-0.52%)]of CHD,which was significantly lower than that[0.83%(0.78%-0.88%)]of the individual with the highest level of HDL-C.Conclusions Our findings revealed that the APOE-HDL-C/total HDL-C ratio was significantly related to a 10-year increased risk of incident CHD,even beyond HDL-C.It seemed that APOE-HDL-C could serve as a new indicator of the anti-atherosclerotic function of HDL.