含有载脂蛋白C-Ⅲ的低密度脂蛋白与冠心病风险

Background:Low-density lipoprotein (LDL) that contains apolipoprotein (apo) C-III makes up only 10% to 20% of plasma LDL but has a markedly altered metabolism and proatherogenic effects on vascular cells. Methods and Results:We examined the association between plasma LDL with apoC-III and coronary heart disease in 320 women and 419 men initially free of cardiovascular disease who developed a fatal or nonfatal myocardial infarction during 10 to 14years of follow-up and matched controls who remained free of coronary heart disease. Concentrations of LDL with apoC-III (measured as apoB in this fraction) were associated with risk of coronary heart disease in multivariable analysis that included the ratio of total cholesterol to high-density lipoprotein cholesterol, LDL cholesterol, apoB, triglycerides, or high-density lipoprotein cholesterol and other risk factors. In all models, the relative risks for the top versus bottom quintile of LDL with apoC-III were greater than those for LDL without apoC-III. When included in the same multivariable-adjusted model, the risk associated with LDL with apoC-III (relative risk for top versus bottom quintile, 2.38; 95% confidence interval, 1.54-3.68; P for trend <0.001) was significantly greater than that associated with LDL without apoC-III (relative risk for top versus bottom quintile, 1.25; 95% confidence interval, 0.76-2.05; P for trend=0.97; P for interaction <0.001). This divergence in association with coronary heart disease persisted even after adjustment for plasma triglycerides. Conclusions:The risk of coronary heart disease contributed by LDL appeared to result to a large extent from LDL that contains apoC-III (Fig 2, Table 2). Table 2: Relative Risks of Coronary Heart Disease During Follow-Up in the Complete Study Sample, According to the Quintile of Low-Density Lipoprotein Types (as Measured by the Apolipoprotein B Concentration in Each Fraction) or Apolipoprotein Concentrations at Baseline Figure 2: Relative risk of coronary heart disease during follow-up in the complete study sample, mutually adjusting for apolipoprotein (apo) B in low-density lipoprotein (LDL) with and without apoC-III. Relative risks and 95% confidence intervals are given for each quintile vs the lowest quintile. A, The model was also adjusted for matching factors, presence or absence of a parental history of coronary heart disease before 60years of age, alcohol intake, and personal history of hypertension. B, The model was adjusted for all variables in A plus personal history of diabetes mellitus and plasma triglycerides. Dark diamonds represent LDL with apoC-III; P for trend <0.001 in A and P for trend=0.07 in B, Light squares represent LDL without apoC-III; P for trend=0.97 in A and P for trend=0.22 in B. P<0.001 for difference in slopes in A and P=0.001 for difference in slopes in B. (Reprinted from Mendivil CO, Rimm EB, Furtado J, et al. Low-density lipoproteins containing apolipoprotein C-III and the risk of coronary heart disease. Circulation. 2011;124:2065-2072, with permission from American Heart Association, Inc.)