甘油三酯与高密度脂蛋白胆固醇比值累积暴露对动脉粥样硬化性心血管疾病的影响

Relationship between the cumulative exposure of triglyceride to high-density lipoprotein cholesterol ratio and the risk of atherosclerotic cardiovascular disease

    摘要
  • 摘要:
    目的 探讨甘油三酯与高密度脂蛋白胆固醇比值（TG/HDL-C）累积暴露对动脉粥样硬化性心血管疾病（ASCVD）的影响。
    方法 采用前瞻性研究方法，以首次参加2006年度或2008年度体检后至2012年至少参加2次健康体检的85 665名开滦集团职工为研究对象，按累积TG/HDL-C四分位分为四组：第1四分位组（＜2.59，n=21 416），第2四分位组（2.59～＜3.78，n=21 416），第3四分位组（3.78～＜5.86，n=21 417）组，第4四分位组（≥5.86，n=21 416）。采用Kaplan-Meier法计算不同组ASCVD的累积发病率。采用Log-rank检验进行组间比较。采用多因素Cox回归模型分析累积TG/HDL-C对ASCVD的影响。
    结果 中位随访时间10.65年，共8 411例（9.82%）研究对象发生ASCVD，6 901例（8.06%）研究对象死亡。在校正混杂因素后，Cox回归分析结果显示：与第1四分位组相比，第2、3、4四分位组ASCVD发病风险分别增加14%（HR=1.14，95%CI：1.06～1.22，P＜0.001）、22%（HR=1.22，95%CI：1.15～1.31，P＜0.001）、37%（HR=1.37，95%CI：1.29～1.47，P＜0.001），且风险呈逐渐增加趋势（P trend ＜0.001）。分层分析结果显示，在累积TG/HDL-C处于高水平的人群中，年龄＜60岁、非高血压、体重指数＜24 kg/m2者的ASCVD发病风险分别高于年龄≥60岁、高血压、体重指数≥24 kg/m2者。
    结论 累积TG/HDL-C与ASCVD 的发生风险呈正相关。长期暴露于高TG/HDL-C可能会增加ASCVD 发生风险，在累积TG/HDL-C处于高水平时，年龄＜60岁人群的ASCVD发病风险高于年龄≥60岁人群，非高血压人群的ASCVD发病风险高于高血压人群，体重指数＜24 kg/m2 人群的ASCVD发病风险高于体重指数≥24 kg/m2 人群。

     

    Abstract:
    Objective  To investigate the effect of cumulative exposure of triglyceride to high density lipoprotein cholesterol ratio (TG/HDL-C) on atherosclerotic cardiovascular disease (ASCVD).
    Methods A prospective study was conducted. A total of 85 665 employees of Kailan Group who participated in physical examination for at least two times from 2006 or 2008 to 2012 were recruited and divided into four groups according to the quartile of cumulative TG/HDL-C: Group Q1 (＜2.59, n=21 416), Q2 (2.59–＜3.78, n=21 416), Q3 (3.78–＜5.86, n=21 417), Q4 (≥5.86, n=21 416). Kaplan-Meier method was used to calculate the cumulative incidence of ASCVD in different groups, and the Log-rank test was used to compare the cumulative incidence of ASCVD among groups. Multivariate Cox regression model was used to analyze the effects of cumulative TG/HDL-C on ASCVD.
    Results During the median follow-up of 10.65 years, 8 411 (9.82%) of the subjects developed ASCVD and 6 901 (8.06%) died. After adjusting for confounding factors, Cox regression analysis showed that compared with group Q1, the risk of ASCVD in groups Q2, Q3 and Q4 increased by 14% (HR=1.14, 95%CI: 1.06–1.22, P＜0.001), 22% (HR=1.22, 95%CI: 1.15–1.31, P＜0.001) and 37% (HR=1.37, 95%CI: 1.29–1.47, P＜0.001), and the risk showed a gradually increasing trend (P＜0.001). Stratified analysis showed that in the population with high cumulative TG/HDL-C, the risk of ASCVD in the group of ＜60 years old, non-hypertensive and body mass index (BMI)＜24 kg/m2 were higher than those in the group of ≥60 years old, hypertensive and BMI≥24 kg/m2, respectively.
    Conclusions  Cumulative TG/HDL-C is positively correlated with the risk of ASCVD. Long-term exposure to high TG/HDL-C may increase the risk of ASCVD. When the cumulative TG/HDL-C is at a high level, the risk of ASCVD in people aged ＜60 years is higher than that in people aged ≥60 years, and the risk in people without hypertension is higher than that in people with hypertension. Subjects with BMI＜24 kg/m2 have a higher risk of ASCVD than those with BMI≥24 kg/m2.

     

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