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Relation between systemic hypertension and blood lipids on the risk of myocardial infarction
J M Gaziano1, H D Sesso, J L Breslow
1Massachusetts Veterans Epidemiology Research and Information Center, Veteran's Affairs Medical Center, Brockton/West Roxbury 02132, USA. gaziano@maveric.org
Insights
Systemic hypertension increases myocardial infarction (MI) risk, potentially through lipid mechanisms. This study suggests high-density lipoprotein cholesterol and triglycerides may mediate hypertension
Area of Science:
- Cardiovascular Medicine
- Epidemiology
- Metabolic Disorders
Background:
- Hypertension and dyslipidemia are established risk factors for coronary heart disease.
- The interplay between systemic hypertension and blood lipids in myocardial infarction (MI) development requires further elucidation.
- Understanding these interactions is crucial for refining cardiovascular risk assessment and prevention strategies.
Purpose of the Study:
- To investigate the potential interactions between systemic hypertension and blood lipid profiles on the risk of nonfatal myocardial infarction (MI).
- To determine if lipid parameters attenuate the observed association between hypertension and MI risk.
Main Methods:
- A case-control study involving 340 first MI cases and 340 matched controls.
- Data collection included various coronary risk factors and fasting blood samples.
- Logistic regression analysis was employed to calculate odds ratios (OR) for MI, adjusting for confounders and exploring lipid interactions.
Main Results:
- Treated hypertension was associated with a significantly increased risk of MI (OR 1.67, 95% CI 1.16 to 2.41) after adjusting for coronary risk factors.
- The association between hypertension and MI risk was substantially attenuated when high-density lipoprotein cholesterol (HDL-C) or triglycerides were included in the model.
- No statistically significant interactions were detected between hypertension and individual lipoprotein parameters.
Conclusions:
- The increased risk of MI associated with treated hypertension may be partly mediated by lipid abnormalities, specifically involving HDL-C and/or triglycerides.
- These findings highlight the complex relationship between hypertension, lipids, and cardiovascular events.
- Further research into lipid-modifying therapies could offer novel strategies for MI prevention in hypertensive patients.
Abstract:
We sought to evaluate the potential interactions between systemic hypertension and blood lipids on the risk of myocardial infarction (MI). Recent evidence suggests that hypertension may interact with other risk factors such as dyslipidemia in the development of coronary heart disease. However, the precise nature of that interrelation remains unclear. We selected 340 cases of first MI and an equal number of age-, sex-, and community-matched controls. Data were collected on a large number of coronary risk factors, and fasting blood samples were obtained. Logistic regression was used to calculate the odds ratio (OR) of nonfatal MI. The age- and sex-adjusted OR of MI was 1.61 (95% confidence interval [CI] 1.15 to 2.25) among treated hypertensives compared with nonhypertensives. Further adjustment for coronary risk factors did not materially alter the results (OR 1.67, 95% CI 1.16 to 2.41). To explore the interrelations among hypertension, lipids, and risk of MI, each lipoprotein parameter was individually added to the risk factor-adjusted multivariate model. The apparent risk associated with hypertension was substantially attenuated by the addition of either high-density lipoprotein cholesterol (OR 1.25, 95% CI 0.82 to 1.90) or triglycerides (OR 1.37, 95% CI 0.91 to 2.05). No significant interactions were found between hypertension and any lipoprotein parameter. These data indicate that the risk of MI associated with treated hypertension may have a lipid mechanism involving high-density lipoprotein cholesterol and/or triglycerides.