冠状动脉对于具有非常高HDL胆固醇的人群中的风险分层
Alexander C Razavi1,2, Anurag Mehta3, Nathan D Wong4
1Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
非常高的HDL胆固醇会增加死亡风险. 冠状动脉 (CAC) 测量是死亡率和动脉样性心血管疾病 (ASCVD) 的更强有力的预测因素,而不是这些人的传统风险因素.
科学领域:
- 心脏病学 心脏病学
- 预防医学 预防医学
- 生物标志物 生物标志物
背景情况:
- 非常高密度脂蛋白 (HDL) 胆固醇水平与死亡率和动脉样硬化心血管疾病 (ASCVD) 的风险增加有悖论的联系.
- 由于这种关联,对患有非常高的HDL胆固醇的个体进行临床风险分层构成重大挑战.
- 传统的风险因素可能无法充分预测这种特定患者群体的结果.
研究的目的:
- 为了调查冠状动脉 (CAC) 在患有非常高高胆固醇的人中的患病率.
- 为了比较CAC的预测能力与传统的风险因素对所有原因的死亡率和ASCVD在这个队列.
- 为提高患有HDL胆固醇升高的患者的风险评估策略.
主要方法:
- 来自CAC联盟的446名患有非常高HDL胆固醇的参与者的分析,随访时间中位数为10.7年.
- 考克斯比例危险回归被用来评估CAC,传统风险因素和死亡率之间的关联.
- 用多民族动脉样硬化研究 (MESA) 的119名参与者的数据进行了验证分析,以评估发生的ASCVD.
主要成果:
- 一半的参与者 (50%) 患有普遍的CAC,平均得分为118.
- 普遍的CAC与3.6倍高的全因死亡风险相关,并且比单个传统风险因素更强大.
- 在验证队列中,普遍的CAC预测了所有原因的死亡率和ASCVD,而传统的风险因素则没有.
结论:
- 冠状动脉 (CAC) 测量可以显著改善患有非常高高达标胆固醇的人的临床风险评估.
- 与传统的风险因素相比,CAC在这个人群中成为不良心血管结果的优越预测因素.
- 整合CAC评估可能会完善因高高脂胆固醇导致心血管风险升高的患者的预防策略.
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