甘油三酯水平与中青年人群急性心肌梗死发病风险的相关性研究

Association Between Triglycerides Level and the Risk of Acute Myocardial Infarction in Young and Middle-aged Population

目的:探讨甘油三酯(TG)水平升高是否增加中青年人群急性心肌梗死(AMI)的发病风险。方法:采用前瞻性队列研究方法,选取2006年6月至2007年10月河北省唐山市开滦集团职工健康查体人群中的中青年人群(女性<65岁、男性<55岁),最终纳入64574例受试者,根据其TG水平三分位(<1.02 mmol/L、1.02~1.66mmol/L、>1.66 mmol/L)分为三组:TG最低三分位组(n=21540)、TG第二三分位组(n=21663)、TG最高三分位组(n=21371)。终点事件为新发AMI。采用多因素Cox回归模型分析TG水平对中青年人群AMI发病风险是否存在影响。结果:TG最低三分位组、TG第二三分位组、TG最高三分位组的平均TG水平分别为(0.74±0.18)mmol/L、(1.30±0.18)mmol/L、(3.09±1.77)mmol/L。随访10.92(4.75,12.83)年,上述三组的AMI发病率及发病密度依次为:0.23%(49/21540)和0.25/千人年、0.40%(87/21663)和0.46/千人年、0.69%(147/21371)和0.80/千人年(P均<0.01)。多因素Cox回归分析显示,与TG最低三分位组相比,TG最高三分位组的发生AMI的风险显著增加(HR=1.59,95%CI:1.12~2.26,P=0.01),但TG第二三分位组的AMI发病风险并未增加(HR=1.28,95%CI:0.89~1.82,P=0.18)。随着TG水平升高,AMI累积发病风险逐渐增加;随访近48个月时,TG水平处于正常范围的TG第二三分位组的AMI累积发病风险也开始增加。结论:TG水平升高是中青年人群发生AMI的独立危险因素。

Objectives:To investigate whether elevated triglycerides(TG)level increases the risk of acute myocardial infarction(AMI)in young and middle-aged population.Methods:This prospective cohort study enrolled 64574 young and middle-aged(female<65 years old and male<55years old)employees of Kailuan Group in Tangshan City,Hebei Province,who took part in the physical examinations between June 2006 and October 2007.According to the 3-quantile TG level(<1.02 mmol/L,1.02-1.66 mmol/L,>1.66 mmol/L)of the included population,participants were divided into low TG tertile group(n=21540),middle TG tertile group(n=21663),and high TG tertile group(n=21371).The endpoint event was new onset AMI.Multivariate Cox regression model was used to analyze if TG level was an independent risk factor of new onset AMI in young and middle-aged population.Results:The TG level was(0.74±0.18)mmol/L,(1.30±0.18)mmol/L,(3.09±1.77)mmol/L,respectively in the low TG tertile group,middle TG tertile group,and high TG tertile group.The median follow-up was 10.92(4.75,12.83)years,the incidence rate and incidence density of AMI were 0.23%(49/21540)and 0.25/1000 person years,0.40%(87/21663)and 0.46/1000 person years,0.69%(147/21371)and 0.80/1000 person years,respectively in the low TG tertile group,middle TG tertile group,and high TG tertile group(both P<0.01).Multivariate Cox regression analysis showed that compared with the low TG tertile group,the risk of AMI was significantly increased in the high TG tertile group(HR=1.59,95%CI:1.12-2.26,P=0.01),but the risk of AMI was similar between the low and middle TG tertile groups(HR=1.28,95%CI:0.89-1.82,P=0.18).The cumulative risk of AMI increased gradually with the increase of TG level.During the follow-up of about 48months,the cumulative risk of AMI also began to increase in the middle TG tertile group.Conclusions:Elevated TG level is an independent risk factor for AMI in young and middle-aged population.