血清甘油三酯水平与动脉粥样硬化性心血管疾病发生风险的前瞻性研究
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摘要
目的:探讨血清甘油三酯(TG)水平与动脉粥样硬化性心血管疾病(ASCVD)发生风险的关系。方法:中美心肺血管疾病流行病学合作研究于1983～1984年在北京和广州的工、农人群中进行基线调查,收集研究对象的心血管相关危险因素水平,并采集空腹静脉血检测血脂等指标。于1987～1988年开始,每隔2年随访一次,随访截止到2005年底,登记并核实研究对象ASCVD(包括冠心病事件和缺血性脑卒中事件)的发生情况。根据基线血清TG水平的四分位数分为四组(切点值分别为0.69 mmol/L、0.95 mmol/L、1.36 mmol/L),使用Cox比例风险回归模型探讨基线不同TG水平与ASCVD发生风险之间的关系。结果:基线共调查35～59岁的研究对象11 336人,剔除有心血管疾病或肿瘤病史(181人)、未采集空腹血标本(1 709人)及其他关键变量缺失者(12人)后,共有9 434人纳入最终分析(其中1～4分位组分别为:2 371人、2 348人、2364人、2 351人)。其中男性4 621人,女性4 813人,基线平均年龄(45.8±6.0)岁,中位血清TG水平为0.95(0.69,1.36)mmol/L。对研究对象平均随访19年后,共发生ASCVD事件632例(6.70%)。从TG第1至第4分位组,ASCVD的发生率依次为4.09%、5.37%、 6.68%和10.68%,呈明显上升趋势(趋势检验P<0.001)。多因素分析调整基线年龄、性别、工农、南北、工作类型、吸烟、饮酒、体育锻炼、体重指数、收缩压、空腹血糖、血清总胆固醇及高密度脂蛋白胆固醇水平后,随着TG水平的升高,ASCVD发生风险呈明显上升趋势(趋势检验P=0.0038),与第1分位组相比,第4分位组ASCVD发病风险增加40%(HR=1.40,95%CI:1.07～1.82)。结论:血清TG水平与ASCVD发生风险呈显著正关联。
Objectives: To explore the relationship between serum triglyceride(TG) and the risk of atherosclerotic cardiovascular disease(ASCVD) in China.Methods: The PRC-USA Collaborative Study of Cardiovascular and Cardiopulmonary Epidemiology was conducted in 1983-1984, this study aimed to prospectively survey the CVD risk factors both in the urban and rural residents of Beijing and Guangzhou, and present study evaluated the association between fasting blood lipids level and the occurrences of ASCVD events based on data derived from the subsequent follow-up from1987-1988 until the end of the year 2005 at two years interval. Participants were divided into 4 groups based on the quartile of TG(the cut-off value were 0.69 mmol/L, 0.95 mmol/L, 1.36 mmol/L). Cox proportional hazard regression model was used to test the relationship between TG and the risk of ASCVD.Results: A total of 11 336 participants aged 35-59 years were surveyed at the baseline, after excluding participants with the history of CVD or cancer(n=181), without fasting blood lipids data(n=1 709) and without other key variables(n =12), 9 434 participants were included in the present analysis [(4 621 men, 4 813 women, with the mean age of 45.8 years, the median level of TG was 0.95(0.69,1.36)]. After a mean follow-up of 19 years, ASCVD occurred in 632(6.70%) participants. From the first to fourth quartile, the incidence of ASCVD was 4.09%, 5.37%, 6.68%, and 10.68%, respectively, with a significant increasing trend(P for trend<0.001). Multivariate analysis after adjusted for age, sex, urban(rural), north(south), work profession, smoke, drink, exercise, systolic blood pressure and other serum biochemical indexes, there was an increasing trend between the risk of ASCVD and the higher TG level at baseline survey, the hazard ratios(HR) in the fourth quartile group was 40% higher than the first quartile TG group(HR=1.40, 95%CI: 1.07-1.82).Conclusions: Serum TG is positively correlated with the risk of ASCVD in Chinese residents participated in this study.
Objectives: To explore the relationship between serum triglyceride(TG) and the risk of atherosclerotic cardiovascular disease(ASCVD) in China.Methods: The PRC-USA Collaborative Study of Cardiovascular and Cardiopulmonary Epidemiology was conducted in 1983-1984, this study aimed to prospectively survey the CVD risk factors both in the urban and rural residents of Beijing and Guangzhou, and present study evaluated the association between fasting blood lipids level and the occurrences of ASCVD events based on data derived from the subsequent follow-up from1987-1988 until the end of the year 2005 at two years interval. Participants were divided into 4 groups based on the quartile of TG(the cut-off value were 0.69 mmol/L, 0.95 mmol/L, 1.36 mmol/L). Cox proportional hazard regression model was used to test the relationship between TG and the risk of ASCVD.Results: A total of 11 336 participants aged 35-59 years were surveyed at the baseline, after excluding participants with the history of CVD or cancer(n=181), without fasting blood lipids data(n=1 709) and without other key variables(n =12), 9 434 participants were included in the present analysis [(4 621 men, 4 813 women, with the mean age of 45.8 years, the median level of TG was 0.95(0.69,1.36)]. After a mean follow-up of 19 years, ASCVD occurred in 632(6.70%) participants. From the first to fourth quartile, the incidence of ASCVD was 4.09%, 5.37%, 6.68%, and 10.68%, respectively, with a significant increasing trend(P for trend<0.001). Multivariate analysis after adjusted for age, sex, urban(rural), north(south), work profession, smoke, drink, exercise, systolic blood pressure and other serum biochemical indexes, there was an increasing trend between the risk of ASCVD and the higher TG level at baseline survey, the hazard ratios(HR) in the fourth quartile group was 40% higher than the first quartile TG group(HR=1.40, 95%CI: 1.07-1.82).Conclusions: Serum TG is positively correlated with the risk of ASCVD in Chinese residents participated in this study.
引文
[1]国家卫生和计划生育委员会.中国卫生和计划生育统计年鉴2015[M].北京:中国协和医科大学出版社,2015.
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[6]Wu Y,Liu X,Li X,et al.Estimation of 10-year risk of fatal and nonfatal ischemic cardiovascular diseases in Chinese adults[J].Circulation,2006,114(21):2217-2225.DOI:10.1161/circulationaha.105.607499.
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[10]Jeppesen J,Hein HO,Suadicani P,et al.Triglyceride concentration and ischemic heart disease:an eight-year follow-up in the Copenhagen Male Study[J].Circulation,1998,97(11):1029-1036.
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[13]Nordestgaard BG,Benn M,Schnohr P,et al.Nonfasting triglycerides and risk of myocardial infarction,ischemic heart disease,and death in men and women[J].JAMA,2007,298(3):299-308.DOI:10.1001/jama.298.3.299.
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[15]Bansal S,Buring JE,Rifai N,et al.Fasting compared with nonfasting triglycerides and risk of cardiovascular events in women[J].JAMA,2007,298(3):309-316.DOI:10.1001/jama.298.3.309.
[16]Di Angelantonio E,Sarwar N,Perry P,et al.Major lipids,apolipoproteins,and risk of vascular disease[J].JAMA,2009,302(18):1993-2000.DOI:10.1001/jama.2009.1619.
[17]Assmann G,Schulte H.The importance of triglycerides:results from the prospective cardiovascular munster(PROCAM)study[J].Eur JEpidemiol,1992,8(Suppl 1):99-103.
[18]Sarwar N,Danesh J,Eiriksdottir G,et al.Triglycerides and the risk of coronary heart disease:10 158 incident cases among 262 525participants in 29 western prospective studies[J].Circulation,2007,115(4):450-458.DOI:10.1161/circulationaha.106.637793.
[19]Iso H,Naito Y,Sato S,et al.Serum triglycerides and risk of coronary heart disease among Japanese men and women[J].Am J Epidemiol,2001,153(5):490-499.
[20]Kim EH,Lee JB,Kim SH,et al.Serum triglyceride levels and cardiovascular disease events in Koreans[J].Cardiology,2015,131(4):228-235.DOI:10.1159/000380941.
[21]Patel A,Barzi F,Jamrozik K,et al.Serum triglycerides as a risk factor for cardiovascular diseases in the Asia-Pacific region[J].Circulation,2004,110(17):2678-2686.DOI:10.1161/01.cir.0000145615.33955.83.
[22]王淼,赵冬,王薇.中国35-64岁人群血清甘油三酯与心血管病发病危险的关系[J].中华心血管病杂志,2008,36(10):940-943.
[23]Rapp JH,Lespine A,Hamilton RL,et al.Triglyceride-rich lipoproteins isolated by selected-affinity anti-apolipoprotein Bimmunosorption from human atherosclerotic plaque[J].Arterioscler Thromb,1994,14(11):1767-1774.
[24]Wang L,Gill R,Pedersen TL,et al.Triglyceride-rich lipoprotein lipolysis releases neutral and oxidized FFAs that induce endothelial cell inflammation[J].J Lipid Res,2009,50(2):204-213.DOI:10.1194/jlr.M700505-JLR200.
[25]Hadi HA,Carr CS,Al Suwaidi J.Endothelial dysfunction:cardiovascular risk factors,therapy,and outcome[J].Vasc Health Risk Manag,2005,1(3):183-198.
[26]Rosenson RS,Davidson MH,Hirsh BJ,et al.Genetics and causality of triglyceride-rich lipoproteins in atherosclerotic cardiovascular disease[J].J Am Coll Cardiol,2014,64(23):2525-2540.DOI:10.1016/j.jacc.2014.09.042.
[27]何伟林,陈纪春,李莹,等.我国队列人群1998~2015年血清总胆固醇水平的变化趋势[J].中国循环杂志,2018,33(5):452-456.DOI:10.3969/j.issn.1000-3614.2018.05.008.
[28]诸骏仁,高润霖,赵水平,等.中国成人血脂异常防治指南(2016年修订版)[J].中国循环杂志,2016,31(10):15-35.DOI:10.3963/j.issn.1000-3614.2016.10.001.
[29]国家卫生计生委疾病预防控制局.中国居民营养与慢性病状况报告(2015年)[M].北京:人民卫生出版社,2015.
[2]Fruchart JC,Sacks F,Hermans MP,et al.The residual risk reduction Initiative:a call to action to reduce residual vascular risk in patients with dyslipidemia[J].Am J Cardiol,2008,102(10 Suppl):1k-34k.DOI:10.1016/s0002-9149(08)01833-x.
[3]Sampson UK,Fazio S,Linton MF.Residual cardiovascular risk despite optimal LDL cholesterol reduction with statins:the evidence,etiology,and therapeutic challenges[J].Curr Atheroscler Rep,2012,14(1):1-10.DOI:10.1007/s11883-011-0219-7.
[4]Miller M,Stone NJ,Ballantyne C,et al.Triglycerides and cardiovascular disease:a scientific statement from the American Heart Association[J].Circulation,2011,123(20):2292-2333.DOI:10.1161/CIR.0b013e3182160726.
[5]An epidemiological study of cardiovascular and cardiopulmonary disease risk factors in four populations in the People's Republic of China.Baseline report from the P.R.C.-U.S.A.Collaborative Study.People's Republic of China--United States cardiovascular and cardiopulmonary epidemiology research group[J].Circulation,1992,85(3):1083-1096.
[6]Wu Y,Liu X,Li X,et al.Estimation of 10-year risk of fatal and nonfatal ischemic cardiovascular diseases in Chinese adults[J].Circulation,2006,114(21):2217-2225.DOI:10.1161/circulationaha.105.607499.
[7]The World Health Organization MONICA Project(monitoring trends and determinants in cardiovascular disease):a major international collaboration.WHO MONICA project principal investigators[J].JClin Epidemiol,1988,41(2):105-114.
[8]Jellinger PS,Smith DA,Mehta AE,et al.American association of clinical endocrinologists'guidelines for management of dyslipidemia and prevention of atherosclerosis[J].Endocr Pract,2012,18(Suppl 1):1-78.
[9]Schwartz GG,Abt M,Bao W,et al.Fasting triglycerides predict recurrent ischemic events in patients with acute coronary syndrome treated with statins[J].J Am Coll Cardiol,2015,65(21):2267-2275.DOI:10.1016/j.jacc.2015.03.544.
[10]Jeppesen J,Hein HO,Suadicani P,et al.Triglyceride concentration and ischemic heart disease:an eight-year follow-up in the Copenhagen Male Study[J].Circulation,1998,97(11):1029-1036.
[11]Chapman MJ,Ginsberg HN,Amarenco P,et al.Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease:evidence and guidance for management[J].Eur Heart J,2011,32(11):1345-1361.DOI:10.1093/eurheartj/ehr112.
[12]Tirosh A,Rudich A,Shochat T,et al.Changes in triglyceride levels and risk for coronary heart disease in young men[J].Ann Intern Med,2007,147(6):377-385.
[13]Nordestgaard BG,Benn M,Schnohr P,et al.Nonfasting triglycerides and risk of myocardial infarction,ischemic heart disease,and death in men and women[J].JAMA,2007,298(3):299-308.DOI:10.1001/jama.298.3.299.
[14]Freiberg JJ,Tybjaerg-Hansen A,Jensen JS,et al.Nonfasting triglycerides and risk of ischemic stroke in the general population[J].JAMA,2008,300(18):2142-2152.DOI:10.1001/jama.2008.621.
[15]Bansal S,Buring JE,Rifai N,et al.Fasting compared with nonfasting triglycerides and risk of cardiovascular events in women[J].JAMA,2007,298(3):309-316.DOI:10.1001/jama.298.3.309.
[16]Di Angelantonio E,Sarwar N,Perry P,et al.Major lipids,apolipoproteins,and risk of vascular disease[J].JAMA,2009,302(18):1993-2000.DOI:10.1001/jama.2009.1619.
[17]Assmann G,Schulte H.The importance of triglycerides:results from the prospective cardiovascular munster(PROCAM)study[J].Eur JEpidemiol,1992,8(Suppl 1):99-103.
[18]Sarwar N,Danesh J,Eiriksdottir G,et al.Triglycerides and the risk of coronary heart disease:10 158 incident cases among 262 525participants in 29 western prospective studies[J].Circulation,2007,115(4):450-458.DOI:10.1161/circulationaha.106.637793.
[19]Iso H,Naito Y,Sato S,et al.Serum triglycerides and risk of coronary heart disease among Japanese men and women[J].Am J Epidemiol,2001,153(5):490-499.
[20]Kim EH,Lee JB,Kim SH,et al.Serum triglyceride levels and cardiovascular disease events in Koreans[J].Cardiology,2015,131(4):228-235.DOI:10.1159/000380941.
[21]Patel A,Barzi F,Jamrozik K,et al.Serum triglycerides as a risk factor for cardiovascular diseases in the Asia-Pacific region[J].Circulation,2004,110(17):2678-2686.DOI:10.1161/01.cir.0000145615.33955.83.
[22]王淼,赵冬,王薇.中国35-64岁人群血清甘油三酯与心血管病发病危险的关系[J].中华心血管病杂志,2008,36(10):940-943.
[23]Rapp JH,Lespine A,Hamilton RL,et al.Triglyceride-rich lipoproteins isolated by selected-affinity anti-apolipoprotein Bimmunosorption from human atherosclerotic plaque[J].Arterioscler Thromb,1994,14(11):1767-1774.
[24]Wang L,Gill R,Pedersen TL,et al.Triglyceride-rich lipoprotein lipolysis releases neutral and oxidized FFAs that induce endothelial cell inflammation[J].J Lipid Res,2009,50(2):204-213.DOI:10.1194/jlr.M700505-JLR200.
[25]Hadi HA,Carr CS,Al Suwaidi J.Endothelial dysfunction:cardiovascular risk factors,therapy,and outcome[J].Vasc Health Risk Manag,2005,1(3):183-198.
[26]Rosenson RS,Davidson MH,Hirsh BJ,et al.Genetics and causality of triglyceride-rich lipoproteins in atherosclerotic cardiovascular disease[J].J Am Coll Cardiol,2014,64(23):2525-2540.DOI:10.1016/j.jacc.2014.09.042.
[27]何伟林,陈纪春,李莹,等.我国队列人群1998~2015年血清总胆固醇水平的变化趋势[J].中国循环杂志,2018,33(5):452-456.DOI:10.3969/j.issn.1000-3614.2018.05.008.
[28]诸骏仁,高润霖,赵水平,等.中国成人血脂异常防治指南(2016年修订版)[J].中国循环杂志,2016,31(10):15-35.DOI:10.3963/j.issn.1000-3614.2016.10.001.
[29]国家卫生计生委疾病预防控制局.中国居民营养与慢性病状况报告(2015年)[M].北京:人民卫生出版社,2015.