高密度脂蛋白胆固醇与老年人群心血管疾病和全因死亡的关系  

Association between high-density lipoprotein cholesterol level and cardiovascular disease and all-cause mortality in the elderly population

作　　者：于佳新[1] 吴寿岭[2] 陈朔华[2] 刘妍[2] 冯明坤 杨阳 李少君 刘晓堃[1] 杨宁[4] 李玉明[4] Yu Jiaxin;Wu Shouling;Chen Shuohua;Liu Yan;Feng Mingkun;Yang Yang;Li Shaojun;Liu Xiaokun;Yang Ning;Li Yuming(Department of Cardiology,Tangshan Worker′s Hospital,Tangshan 063000,China;Department of Cardiology,Kailuan General Hospital,Tangshan 063000,China;Tangshan Hospital of Traditional Chinese Medicine,Clinical Laboratory,Tangshan 063000,China;Department of Cardiology,TEDA International Cardiovascular Hospital,Tianjin 300457,China)

机构地区：[1]唐山市工人医院心内科,唐山063000 [2]开滦总医院心内科,唐山063000 [3]唐山市中医医院检验科,唐山063000 [4]天津医科大学心血管病临床学院,泰达国际心血管病医院心内科,天津300457

出　　处：《中华心血管病杂志》2022年第8期791-798,共8页Chinese Journal of Cardiology

摘　　要：目的探讨高密度脂蛋白胆固醇(HDL-C)与老年人群心血管疾病(CVD)和全因死亡的关系。方法本研究为前瞻性队列研究。选取参加2006年度开滦集团健康体检且年龄≥65岁的老年人作为观察对象。根据HDL-C水平,将观察对象分为4组:低水平组(HDL-C<1.30 mmol/L),中水平组(1.30 mmol/L≤HDL-C≤1.54 mmol/L),中高水平组(1.55 mmol/L≤HDL-C≤1.80 mmol/L),高水平组(HDL-C≥1.81 mmol/L)。收集并比较各组的年龄、性别、血脂水平等基线资料,随访至2019年12月31日,记录终点事件CVD、全因死亡。校正混杂因素后,以中高水平组为对照组,采用Cox比例风险回归模型评估HDL-C对CVD及全因死亡事件的影响;采用限制性立方样条回归模型评估HDL-C水平与CVD及全因死亡之间的线性或非线性关系;进行死亡竞争风险分析,分别去除随访1年内发生CVD或全因死亡事件的观察对象、去除女性观察对象后,进行敏感性分析。结果共纳入观察对象14355例,年龄(71.5±5.5)岁,男性12607例(87.8%),随访时间(10.9±3.3年)。Cox比例风险回归模型结果显示,与中高水平组相比,低水平组发生CVD事件HR值(95%CI)为1.21(1.06~1.38)(P<0.05),全因死亡HR值(95%CI)为1.02(0.95~1.11)(P>0.05);高水平组发生CVD事件HR值(95%CI)为1.17(1.03~1.33)(P<0.05),全因死亡HR值(95%CI)为1.07(1.00~1.16),全因死亡风险有增高的趋势(0.05<P<0.1)。限制性立方样条回归模型显示HDL-C与CVD为非线性相关(非线性关联P<0.1),呈U形曲线趋势,与全因死亡为线性相关(非线性关联P>0.1)。结论在老年人群中,HDL-C水平为1.55~1.80 mmol/L时CVD的风险最低,HDL-C过高或过低均是CVD的危险因素,HDL-C过高时全因死亡风险有增高的趋势,未见HDL-C过低致全因死亡的风险增加。Objective To investigate the relationship between high density lipoprotein cholesterol(HDL-C)and cardiovascular disease(CVD)and all-cause mortality in the elderly population.Methods A total of 14355 elderly persons aged≥65 years,who participated in the annual physical examination in Kailuan Group in 2006 were included in this prospective cohort study.According to HDL-C level,the participants were divided into 4 groups:low-level group(HDL-C<1.30 mmol/L),intermediate-level group(1.30 mmol/L≤HDL-C≤1.54 mmol/L),medium-high-level group(1.55 mmol/L≤HDL-C≤1.80 mmol/L),high-level group(HDL-C≥1.81 mmol/L).Baseline data such as age,sex and blood lipid levels were collected and compared.Inpatient medical records and death information were obtained through the social security system,and CVD and all-cause mortality were analyzed.After adjusting for confounding factors,the medium-high-level group was used as the reference group.Cox proportional risk regression model was used to evaluate the impact of HDL-C on CVD and all-cause mortality events.The linear or nonlinear relationship between HDL-C level and CVD and all-cause mortality events was evaluated by restricted cubic spline regression model.Death competitive risk analysis was conducted,and sensitivity analysis was performed after excluding subjects with CVD or all-cause mortality within 1 year of follow-up and female participants.Results The average age of this cohort was(71.5±5.5)years and follow-up time was(10.9±3.3)years.Compared with medium-high-level group,Cox proportional risk regression analysis showed that the HR(95%CI)of CVD and all-cause mortality in low-level group were 1.21(1.06-1.38)(P<0.05)and 1.02(0.95-1.11)(P>0.05),respectively;the HR(95%CI)of CVD events in high-level group was 1.17(1.03-1.33)(P<0.05),and there was a marginal significant association with all-cause mortality,the HR(95%CI)was 1.07(1.00-1.16)(0.05<P<0.1).The restricted cubic spline regression analysis showed that HDL-C was nonlinearly correlated with CVD(nonlinear correlation P<0

关 键 词：老年人 高密度脂蛋白胆固醇 心血管疾病 全因死亡 

分 类 号：R54[医药卫生—心血管疾病]