我国中年人群载脂蛋白B与载脂蛋白A-1比值对冠心病事件预测作用的研究

Predictive Value of the Ratio of Apolipoprotein B/A-1 Alone or in Combination With Blood Pressure on Coronary Artery Disease in Middle-aged Chinese Adults

目的:探究载脂蛋白B与载脂蛋白A-1比值(apoB/apoA-1)对冠心病事件的独立预测作用以及血压和apoB/apoA-1两因素对冠心病事件的联合作用。方法:卫生行业科研专项“心血管疾病监测、预防预警和诊治技术应用研究”开始于2009~2010年,2016~2017年通过面对面、电话和死亡登记对研究对象进行随访。根据apoB/apoA-1的中位数将研究对象分为apoB/apoA-1<0.64组(n=4443)和apoB/apoA-1≥0.64组(n=4285)。结果:经过中位随访时间为6.35年的随访,在最终纳入分析的8728例研究对象中,有88例发生了冠心病事件。在调整年龄、性别、血压水平和其它危险因素后,随着apoB/apoA-1的增高,冠心病事件的发生风险也随之增加[HR(95%CI):5.18(2.18~12.33),P<0.001]。apoB/apoA-1<0.64组血压正常者冠心病事件的发生率为0.73/1000人年;而apoB/apoA-1≥0.64组合并高血压患者冠心病事件发生率为3.77/1000人年。在全部发生冠心病事件病例中由apoB/apoA-1增高与高血压的相加交互作用所引起的病例占52.2%[95%CI:0.23~0.82,P=0.024]。结论:apoB/apoA-1增高,特别是与高血压同存时,冠心病事件的发生风险明显增加。因而,在中国人群中预防冠心病事件需要apoB/apoA-1和血压同时关注。

Objectives: To investigate the impact of ratio of apolipoprotein B(apoB)/apolipoprotein A-1(apoA-1) alone or in combination with blood pressure(BP) on the risk of coronary artery disease(CAD) in Chinese middle-aged adults.Methods: The cardiovascular disease risk factor study in China was conducted in 2009-2010. Follow-up were conducted via clinical visits, telephone, or death certification until 2016-2017. Participants were divided into low(<0.64) and high apoB/apoA-1 ratio(≥0.64) groups according to the median of apoB/apoA-1.Results: The median duration of follow-up was 6.35 years. 88 out of 8 728 participants developed CAD. After adjusting the age, sex, BP level and other cardiovascular risk factors, there was a significant linear trend between apoB/apoA-1 ratio and risk of CAD(HR=5.18 [95% CI:2.18-12.33], P<0.001). The incidence of CAD was 0.73 per 1 000 person-years in those with both low apoB/apoA-1 ratio(<0.64) and normotension;and 3.77 per 1 000 person-years in those with both high apoB/apoA-1 ratio(≥0.64) and hypertension. Among the participants with both high apoB/apoA-1 ratio and hypertension, about 52.2%(95%CI: 0.23-0.82, P=0.024) of the risk of CAD was attributed to the interaction between high apoB/apoA-1 and hypertension.Conclusions: High apoB/apoA-1 ratio, especially the combination with hypertension, is associated with the increased risk of CAD, thus, joint interventions on apoB/apoA-1 ratio and hypertension might play an important role in prevention of CAD in middle-aged Chinese adults.