HDL和冠心病課件

1、HDL and Coronary Heart DiseaseEpidemiology of CHDHDL and Coronary Heart DiseaseHDL-C Distribution in US AdultsRF = risk factorsData from NHANES III, 19881994HDL-C (mg/dL) 3535 4545 60 60CHD0246810121416 2 RF, no CHDNo. of US adults (millions)HDL-C Distribution in US AdultCHD Risk According to HDL-C

2、LevelsFramingham Study4.03.02.01.0254565HDL-C (mg/dL)CHD risk ratioKannel WB. Am J Cardiol 1983;52:9B12B.Copyright 1983, with permission from Excerpta Medica Inc.2.01.004.0CHD Risk According to HDL-C LeCHD Risk According to Total-C/HDL-C RatioFramingham Study (Men)Kannel WB. Am J Cardiol 1987;59:80A

3、90A3.02.52.01.51.00.52.04.06.08.010.012.0Total-C/HDL-C ratioCHD risk ratio3.44.49.6CHD Risk According to Total-C/CHD Risk According to HDL-C LevelsProspective Cardiovascular Mnster Study1103021020406080100120 55Incidenceper 1,000 (in 6 years)HDL-C (mg/dL)Assmann G, ed. Lipid Metabolism Disorders and

4、 Coronary Heart Disease. Munich: MMV Medizin Verlag, 1993186 events in 4,407 men (aged 4065 y)CHD Risk According to HDL-C LeLow HDL-C Levels Increase CHD Risk Even When Total-C Is Normal (Framingham)Risk of CHD by HDL-C and Total-C levels; aged 4883 yCastelli WP et al. JAMA 1986;256:2835283802468101

5、214 4040495059 60 5.0*LDL-C/HDL-C ratioIncidenceper 1,000 (in 6 years)TG 200 mg/dLTG 200 mg/dLHypertriglyceridemia IncreasesFrequency of Low HDL-C Compared With Other Risk Factors in Men With Premature CHD Cases Controls (n = 321)Risk factor (n = 601) Not adjustedAdjustedCigarette smoking29%67%* HDL

6、-C 35 mg/dL19%63%* 57%*Hypertension (BP 150/90)21%41%* LDL-C 160 mg/dL26%26%34%*Diabetes mellitus 1%12%* *Significantly different from controls (P 0.001)Genest JJ et al. Am J Cardiol 1991;67:11851189Frequency of Low HDL-C CompareDistribution of HDL-C Levels in Men With CHDVA-HIT Study GroupHDL-C lev

7、el Whites BlacksAll subjects (mg/dL) (n = 2,891)(n = 572)(n = 8,578) 40 32%57%36%Rubins HB et al. Am J Cardiol 1995;75:1196120163%Distribution of HDL-C Levels iCHD Incidence Related to HDL-C Levels in Various Trials95% confidence intervals (CIs) for adjusted proportional hazards regression coefficie

8、nts. FHS = Framingham Heart Study; LRCF = Lipid Research Clinics Prevalence Mortality Follow-up Study; CPPT = Lipid Research Clinics Coronary Primary Prevention Trial; MRFIT = Multiple Risk Factor Intervention TrialGordon DJ et al. Circulation 1989;79:815% change in risk per 1 mg/dL increment in HDL

9、-C0-2-4-6-8-10FHSLRCFCPPTMRFITFHSLRCFCHD incidenceMenWomenCHD Incidence Related to HDL-CPopulation, Gender, and Ethnic Variability in HDL-C Levels Mean HDL-C level (mg/dL)Population MenWomenUnited States (NHANES III)1Whites4454African-Americans5155Turkey (Turkish Heart Study)237421. NHANES III, 1988

10、1994 (unpublished data)2. Mahley RW et al. J Lipid Res 1995;36:839859Population, Gender, and EthnicEthnic Variations in Lipid Parameters Insulin Resistance Atherosclerosis Study African-Non-HispanicAmericans Hispanics Whites P valuen462 (27%)546 (34%) 612 (38%) 0.001Total-C (mg/dL)212.5211.1213.20.7

11、82LDL-C (mg/dL)143.8139.4140.70.410HDL-C (mg/dL)47.042.344.0 0.001TG (mg/dL)102.1147.7134.0 0.001LDL size ()262.1257.6259.2 0.001Haffner SM et al. Arterioscler Thromb Vasc Biol 1999;19:22342240.Ethnic Variations in Lipid ParChanging Mortality Rates Over Time for CHD in Patients With and Without Diab

12、etesSubjects aged 3574 yGu K et al. JAMA 1999;281:12911297177.414.24.26.82.47.61.9024681012141618-16.6%(P = 0.46)+10.7%(P = 0.76)-43.8%(P 0.001)-20.4%(P = 0.12)Men(NHANES I, 197175)Men(NHEFS, 198284)Women(NHANES I, 197175)Women(NHEFS, 198284)DiabeticNondiabeticMortality rate (%)per 1,000 person-year

13、sChanging Mortality Rates Over Differences in CVD Risk Factors byDiabetes Status in Men and WomenThe Strong Heart Study-7.5*Men (n = 1,846)Women (n = 2,703) *P = 0.0005; P = 0.0120Adapted from Howard BV et al. Diabetes Care 1998;21:12581265-4.4-3.7-5.3-8-7-6-5-4-3-2-10HDL-C(mg/dL)LDL size()Differenc

14、es between subjects with and without diabetesNative AmericansDifferences in CVD Risk FactorProbability of Death From CHD in Patients With NIDDM and in Nondiabetic Patients, With and Without Prior MIKaplan-Meier estimatesHaffner SM et al. N Engl J Med 1998;339:229234. Copyright 1998, Massachusetts Me

15、dical Society. All rights reserved.012345678020406080100Nondiabetic subjects without prior MIDiabetic subjects without prior MINondiabetic subjects with prior MIDiabetic subjects with prior MIYearsSurvival (%)Probability of Death From CHD Potential Risk Factors for CHD in 2,693 White Patients With N

16、IDDMUnited Kingdom Prospective Diabetes Study280 pts with CHDTurner RC et al. BMJ 1998;316:8238281111.480.871.632.290.511.9300.51.01.52.02.5LDL-CHDL-CTG1st2nd3rd1st2nd3rd1st2nd3rdTertileTertileTertileEstimated hazard ratioP 0.001P 0.001P 0.001Potential Risk Factors for CHDStepwise Selection of Risk

17、Factors in 2,693 White Patients With NIDDMUnited Kingdom Prospective Diabetes StudyCoronary heart disease (n = 280) Position in modelVariable P value1stLDL-C0.00012ndHDL-C0.00013rdHemoglobin A1c0.00224thSystolic blood pressure0.00655thSmoking0.056Turner RC et al. BMJ 1998;316:823828Stepwise Selectio

18、n of Risk FacRisk Factors for CHD in NIDDMUnited Kingdom Prospective Diabetes Study“Triglyceride concentration was a risk factor for coronary artery disease after adjustment for age and sex, but it was not an independent risk factor when the other variables were included in the model.”Turner RC et a

19、l. BMJ 1998;316:823828Risk Factors for CHD in NIDDMBaseline Anthropometric Variables andCV Risk Factors in Subjects With Normal Glucose Tolerance (San Antonio Heart Study) Conversion status at follow-upDiabetes Normal (n = 18)(n = 490) P valueBody mass index (kg/m2)28.227.20.472TG (mmol/L)1.831.280.006HDL-C (mmol/L)1.141.280.045Systolic BP (mm Hg)116.8108.80.004Fasting glucose (mmol/L)5.285.000.032Fasting insulin (pmol/L)157810.006Haffner SM et al. JAMA 1990;263:28932898Baseline Anthropom