在apoB,非高密度脂蛋白胆固醇和甘油三之间存在不一致:对心血管预防的影响
Allan D Sniderman1, Line Dufresne1, Karol M Pencina1,2
1Mike and Valeria Rosenbloom Centre for Cardiovascular Prevention, Department of Medicine, McGill University Health Centre-Royal Victoria Hospital, 1001 Boulevard Décarie, Montreal, Québec H4A 3J1, Canada.
European heart journal
|May 3, 2024
概括
脂蛋白B (apoB) 是动脉样硬化心血管疾病 (ASCVD) 风险的优越标志物,比LDL-C,非HDL-C和甘油三. 这些标准的脂质标记在临床实践中不足以准确评估ASCVD风险.
科学领域:
- 心血管医学 心血管医学
- 脂质学 脂质学是指脂质学.
- 预防性心脏病学 预防性心脏病学
背景情况:
- 脂蛋白B (apoB) 被认为是动脉样硬化心血管疾病 (ASCVD) 风险的更准确标志物.
- 临床采用apoB测试仍然很低,常规护理依赖于低密度脂蛋白胆固醇 (LDL-C),非高密度脂蛋白胆固醇 (HDL-C) 和甘油三.
- 这项研究调查了标准脂质标志物对心血管风险评估的充分性.
研究的目的:
- 评估LDL-C,非HDL-C和甘油三是否是apoB在预测ASCVD风险方面的适当替代品.
- 为了确定不同水平的标准脂质标记物的apoB的变异性.
- 评估超越标准脂质测量的apoB的独立预测值.
主要方法:
- 对一大批英国生物库队列 (293,876名成年人) 的分析,新发ASCVD的中位数随访时间为11年.
- 与LDL-C,非HDL-C和甘油三相对的apoB分布的图形检查.
- 在考虑标准脂质后构建apoB残留物以评估使用比例危险回归来评估ASCVD事件的独立预测值.
主要成果:
- ApoB与LDL-C和非HDL-C的相关性很高 (r=.96),但与甘油三 (r=.42) 的相关性较低.
- 在给定水平的LDL-C,非HDL-C和甘油三中观察到广泛的apoB值范围,表明显著的变化.
- 在对LDL-C,非HDL-C和HDL-C进行调整后,残留的apoB独立预测了新出现的ASCVD事件,而在包括apoB时,标准脂质残留并没有保持显著.
结论:
- 在标准脂质水平下apoB的显著变化及其对ASCVD事件的独立预测能力表明LDL-C,非HDL-C和甘油三作为唯一风险评估工具的不足.
- ApoB提供了关键的风险信息,这些风险信息没有被传统的脂质资料所捕获.
- 常规临床护理应考虑apoB测量,以更准确地分层ASCVD风险.
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