低密度脂蛋白大小,普拉瓦斯塔丁治疗和冠状动脉事件
H Campos1, L A Moye, S P Glasser
1Department of Nutrition, Bldg 2, Room 353A, Harvard School of Public Health, 665 Huntington Ave, Boston, MA 02115, USA. hcampos@hsph.harvard.edu
JAMA
|September 27, 2001
概括
较大的LDL颗粒大小独立预测了心肌梗塞患者的冠状动脉事件. 然而,普拉瓦斯塔丁治疗消除了这种增加的风险,这表明当LDL胆固醇得到有效管理时,可能不需要临床评估LDL大小.
科学领域:
- 心脏病学 心脏病学
- 脂质代谢 脂质代谢是什么
- 预防医学 预防医学
背景情况:
- 小低密度脂蛋白 (LDL) 颗粒大小是冠心病 (CHD) 的假设危险因素.
- 动物模型表明大LDL和动脉样硬化之间存在联系.
- 小 LDL 与其他风险因素之间的关联使人类心脏病的独立预测变得复杂.
研究的目的:
- 为了确定LDL颗粒大小是否可以独立预测已确定的冠心病患者的复发性冠心病事件.
- 区分LDL大小作为独立预测指标与其他脂质异常的标记.
主要方法:
- 在胆固醇和复发性事件 (CARE) 试验中进行的一项前性,嵌套的病例对照研究.
- 包括416个病例和421个对照患者,他们在典型的LDL度下幸存了心肌梗塞.
- 在5年内对随后的心肌梗塞或冠状动脉死亡进行了分析,分为LDL颗粒大小五分之一和治疗组.
主要成果:
- 病例和对照 (25.6 nm) 的平均LDL大小相似.
- 在安慰剂组中,更大的LDL大小 (最高与最低五分位数) 在调整风险因素后预测了冠心病事件 (RR 4.00;95% CI 1.81-8.82).
- 在接受普拉瓦斯塔丁治疗的患者中没有观察到这种风险增加 (P = .046的相互作用).
结论:
- 较大的LDL颗粒大小独立预测了心肌梗塞幸存者的冠状动脉事件.
- 普拉瓦斯塔丁治疗抵消了LDL大小对冠状动脉事件的不良影响.
- 如果有效治疗LDL胆固醇,LDL大小评估的临床效用可能是有限的.
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