70-100歲人群LDL膽固醇升高增加心肌梗死和動脈粥樣硬化性心血管疾病風險
作者:
小柯機器人發布時間:2020/11/14 17:27:13
丹麥哥本哈根大學醫院Børge Grønne Nordestgaard團隊研究了70-100歲人群低密度脂蛋白(LDL)膽固醇升高與心肌梗死和動脈粥樣硬化性心血管疾病風險增加之間的相關性。2020年11月10日,該研究發表在《柳葉刀》雜誌上。
歷史研究發現,在70歲以上的患者中,LDL膽固醇升高與心肌梗死和動脈粥樣硬化性心血管疾病的風險增加無關。
為了在當代70-100歲的人群中檢驗這一假設,研究組招募基線檢查時沒有動脈粥樣硬化性心血管疾病或糖尿病,也沒有服用他汀類藥物的參與者(年齡在20-100歲之間),均接受LDL膽固醇檢測。研究組計算了心肌梗死和動脈粥樣硬化性心血管疾病的風險比(HRs)和絕對事件率,並估計了5年內預防一次事件所需治療(NNT)的數量。
2003年11月25日至2015年2月17日,研究組共招募了91131名參與者,平均隨訪7.7年後,1515名首次發生心肌梗死,3389名患有動脈粥樣硬化性心血管疾病。LDL膽固醇每增加1.0 mmol/L,心肌梗死的風險比為1.34,在所有年齡組,特別是70-100歲的人群中,心肌梗死的風險均增加了。LDL膽固醇每增加1.0 mmol/L,動脈粥樣硬化性心血管疾病的風險比為1.16,在所有年齡組,特別是70-100歲年齡組中風險顯著增加。
在80-100歲和70-79歲的人群中,LDL膽固醇水平與低於3.0 mmol/L相比,高於5.0 mmol/L時,心肌梗死的風險顯著增加,風險比分別為2.99和1.82。LDL膽固醇水平每升高1.0 mmol/L,每1000人年心肌梗死和動脈粥樣硬化性心血管疾病事件的發生率在70-100歲的人群中最高,年紀越輕,事件數量越少。如果所有人都服用中等強度的他汀類藥物,則5年內預防一次心肌梗死或動脈粥樣硬化性心血管疾病事件的NNT在年齡為70-100歲的人群眾最低,但隨著年齡的增長而增加。
總之,70-100歲LDL膽固醇升高的人群患心肌梗死和動脈粥樣硬化性心血管疾病的絕對風險最高,5年內可預防一次事件的估計NNT最低。
附:英文原文
Title: Elevated LDL cholesterol and increased risk of myocardial infarction and atherosclerotic cardiovascular disease in individuals aged 70–100 years: a contemporary primary prevention cohort
Author: Martin Bdtker Mortensen, Brge Grnne Nordestgaard
Issue&Volume: 2020-11-10
Abstract:
Background
Findings of historical studies suggest that elevated LDL cholesterol is not associated with increased risk of myocardial infarction and atherosclerotic cardiovascular disease in patients older than 70 years. We aimed to test this hypothesis in a contemporary population of individuals aged 70–100 years.
Methods
We included in our analysis individuals (aged 20–100 years) from the Copenhagen General Population Study (CGPS) who did not have atherosclerotic cardiovascular disease or diabetes at baseline and who were not taking statins. Standard hospital assays were used to measure LDL cholesterol. We calculated hazard ratios (HRs) and absolute event rates for myocardial infarction and atherosclerotic cardiovascular disease, and we estimated the number needed to treat (NNT) in 5 years to prevent one event.
Findings
Between Nov 25, 2003, and Feb 17, 2015, 91131 individuals were enrolled in CGPS. During mean 7·7 (SD 3·2) years of follow-up (to Dec 7, 2018), 1515 individuals had a first myocardial infarction and 3389 had atherosclerotic cardiovascular disease. Risk of myocardial infarction per 1·0 mmol/L increase in LDL cholesterol was augmented for the overall population (HR 1·34, 95% CI 1·27–1·41) and was amplified for all age groups, particularly those aged 70–100 years. Risk of atherosclerotic cardiovascular disease was also raised per 1·0 mmol/L increase in LDL cholesterol overall (HR 1·16, 95% CI 1·12–1·21) and in all age groups, particularly those aged 70–100 years. Risk of myocardial infarction was also increased with a 5·0 mmol/L or higher LDL cholesterol (ie, possible familial hypercholesterolaemia) versus less than 3·0 mmol/L in individuals aged 80–100 years (HR 2·99, 95% CI 1·71–5·23) and in those aged 70–79 years (1·82, 1·20–2·77). Myocardial infarction and atherosclerotic cardiovascular disease events per 1000 person-years for every 1·0 mmol/L increase in LDL cholesterol were highest in individuals aged 70–100 years, with number of events lower with younger age. The NNT in 5 years to prevent one myocardial infarction or atherosclerotic cardiovascular disease event if all people were given a moderate-intensity statin was lowest for individuals aged 70–100 years, with the NNT increasing with younger age.
Interpretation
In a contemporary primary prevention cohort, people aged 70–100 years with elevated LDL cholesterol had the highest absolute risk of myocardial infarction and atherosclerotic cardiovascular disease and the lowest estimated NNT in 5 years to prevent one event. Our data are important for preventive strategies aimed at reducing the burden of myocardial infarction and atherosclerotic cardiovascular disease in the growing population aged 70–100 years.
DOI: 10.1016/S0140-6736(20)32233-9
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32233-9/fulltext