- 學位論文
血脂基準值合併血脂變化量對心血管疾病和全死因風險的相關性研究:全國代表性世代追蹤研究
Association of Baseline as well as Change in Lipid Levels with the Risk of Cardiovascular Diseases and All-Cause Deaths: A Representative Cohort Study in Taiwan
摘要
背景 致動脈粥狀硬化的血脂値上升已確定為心血管事件風險的危險因子。但是關於血脂改變對心血管和全死因風險的作用的證據目前尚無定論。 方法 根據台灣三高主題資料庫進行一全國代表性的社區前瞻性世代研究（4072成年人，平均44.8歲，53.5%女性）。在2002年和2007年進行了兩次次血脂測量。將血脂基準值和其變化量分為四類:包括低和高風險血脂基準值合併穩定或減少的血脂變化和增加的血脂變化。 結果 在中位數13.3年的追蹤中確定了新發的225心血管事件（n=225）和全因死亡（n=345）。與下降和低非高密度膽固醇值的參與者相比，增加非高密度膽固醇值的參與者有較高的心血管疾病的風險（調整後的危險比[HR]，1.32，95％信賴區間[CI]，0.75-2.32，於低非高密度膽固醇值;HR，1.64，95％CI，0.97-2.77，於高非高密度膽固醇值）。與下降和低非高密度膽固醇值的人相比，增加非高密度膽固醇值的參與者的全因死亡風險為較低（低非高密度膽固醇值，HR，0.59，95％CI，0.37-0.94;低非高密度膽固醇值，HR，0.57，95％CI，0.36-0.90）。在其他脂質變化中觀察到了類似的心血管事件和全死因風險的模式。 結論 血脂基準值和其變化量與心血管疾病的風險顯著相關，而與全死因風險呈負相關。尚須進一步研究來釐清血脂基準值和其變化量與心血管疾病和全死因的風險的生物學機制。
並列摘要
Background High baseline atherogenic lipid level has been an established risk factor for the risk of cardiovascular events. However, evidence about the role of lipid change for cardiovascular and death risks was inconclusive. Methods A cohort study based on the Taiwanese Survey on Hypertension, Hyperglycemia, and Hyperlipidemia (n, 4072, mean 44.8 years, 53.5% women) was conducted with repeated lipid measurements during 2002 and 2007. Combined baseline and change of lipid levels were classified into four groups, including stable or decreasing lipid change and increasing lipid change with low and high-risk baseline lipid levels. Results New developing cardiovascular events (n, 225), and all-cause deaths (n, 345) were ascertained during a median of 13.3 years’ follow-up. Compared with those in decreasing and lower nonHDL cholesterol, participants in increasing nonHDL cholesterol level were likely to have a cardiovascular risk (adjusted hazard ratio [HR], 1.32, 95% confidence interval [CI], 0.75-2.32, for low NonHDL; HR, 1.64, 95% CI, 0.97-2.77, for high HDL level). Compared with those in decreasing and lower NonHDL cholesterol, participants in increasing NonHDL cholesterol level were likely to have a lower risk for all-cause death (adjusted HR, 0.59, 95%CI, 0.37-0.94, for low NonHDL; HR, 0.57, 95% CI, 0.36-0.90, for high NonHDL). Similar patterns for cardiovascular events and all-cause death were observed across other lipid change. Conclusion Baseline and the change in lipid profiles were significantly associated with the risk of cardiovascular diseases and inversely associated with the all-cause death. Further studies about biological mechanism for the role of baseline and change in lipid levels are warranted.