LDL-C水平過高或過低均會增加全因死亡的風險
作者：
小柯機器人發布時間：2020/12/10 16:24:18
丹麥哥本哈根大學醫院Børge Grønne Nordestgaard團隊研究了丹麥居民低密度脂蛋白膽固醇與全因死亡風險的相關性。2020年12月8日，該研究發表在《英國醫學雜誌》上。
為了確定低密度脂蛋白膽固醇（LDL-C）水平與全因死亡率之間的相關性，以及LDL-C水平與一般人群全因死亡最低風險之間的關係，研究組在丹麥進行了一項前瞻性隊列研究，2003-2015年招募參與者，平均隨訪9.4年，主要結局為全因死亡率，次要結局為特定原因死亡率。
在108243名20-100歲的參與者中，有11376名（10.5％）在研究期間死亡，死亡中位年齡為81歲。LDL-C水平與全因死亡風險之間呈U型關聯，過低或過高均會增加全因死亡的風險。與LDL-C水平為3.4-3.9 mmol/L（132-154 mg/dL）的參與者相比，當LDL-C水平小於1.8 mmol/L（<70 mg/dL）時，全因死亡的多變量校正風險比為1.25；當LDL-C水平超過4.8 mmol/L（>189 mg/dL） 時，風險比為1.15。
在總體人群和未接受降脂治療的參與者中，LDL-C的水平為3.6 mmol/L（140 mg/dL） 時，全因死亡的風險最低，而在接受降脂治療的個體中，LDL-C水平為2.3 mmol/L（89 mg/dL）時全因死亡風險最低。在各個年齡段的男性和女性中，除心血管死亡率外，對於癌症和其他原因死亡率均觀察到相似結果。LDL-C水平的任何升高都與心肌梗死風險增加有關。
研究結果表明，在一般人群中，LDL-C水平過高或過低均會增加全因死亡的風險，且LDL-C水平為3.6 mmol/L時，全因死亡風險最低。
附：英文原文
Title: Association between low density lipoprotein and all cause and cause specific mortality in Denmark: prospective cohort study
Author: Camilla Ditlev Lindhardt Johannesen, Anne Langsted, Martin Bdtker Mortensen, Brge Grnne Nordestgaard
Issue&Volume: 2020/12/08
Abstract:
Objective To determine the association between levels of low density lipoprotein cholesterol (LDL-C) and all cause mortality, and the concentration of LDL-C associated with the lowest risk of all cause mortality in the general population.
Design Prospective cohort study.
Setting Denmark; the Copenhagen General Population Study recruited in 2003-15 with a median follow-up of 9.4 years.
Participants Individuals randomly selected from the national Danish Civil Registration System.
Main outcome measures Baseline levels of LDL-C associated with risk of mortality were evaluated on a continuous scale (restricted cubic splines) and by a priori defined centile categories with Cox proportional hazards regression models. Main outcome was all cause mortality. Secondary outcomes were cause specific mortality (cardiovascular, cancer, and other mortality).
Results Among 108243 individuals aged 20-100, 11376 (10.5%) died during the study, at a median age of 81. The association between levels of LDL-C and the risk of all cause mortality was U shaped, with low and high levels associated with an increased risk of all cause mortality. Compared with individuals with concentrations of LDL-C of 3.4-3.9 mmol/L (132-154 mg/dL; 61st-80th centiles), the multivariable adjusted hazard ratio for all cause mortality was 1.25 (95% confidence interval 1.15 to 1.36) for individuals with LDL-C concentrations of less than 1.8 mmol/L (<70 mg/dL; 1st-5th centiles) and 1.15 (1.05 to 1.27) for LDL-C concentrations of more than 4.8 mmol/L (>189 mg/dL; 96th-100th centiles). The concentration of LDL-C associated with the lowest risk of all cause mortality was 3.6 mmol/L (140 mg/dL) in the overall population and in individuals not receiving lipid lowering treatment, compared with 2.3 mmol/L (89 mg/dL) in individuals receiving lipid lowering treatment. Similar results were seen in men and women, across age groups, and for cancer and other mortality, but not for cardiovascular mortality. Any increase in LDL-C levels was associated with an increased risk of myocardial infarction.
Conclusions In the general population, low and high levels of LDL-C were associated with an increased risk of all cause mortality, and the lowest risk of all cause mortality was found at an LDL-C concentration of 3.6 mmol/L (140 mg/dL).
DOI: 10.1136/bmj.m4266
Source: https://www.bmj.com/content/371/bmj.m4266