游离高密度脂蛋白胆固醇水平低与冠心病风险增加相关：对23项亚太地区研究中个体受试者数据的Meta分析

Background:Previous studies have suggested that there is a novel dyslipidemic profile consisting of isolated low high-density lipoprotein cholesterol (HDL-C) level that is associated with increased risk of coronary heart disease, and that this trait may be especially prevalent in Asian populations. Methods and Results:Individual participant data from 220 060 participants (87% Asian) in 37 studies from the Asia-Pacific region were included. Low HDL-C (HDL <1.03mmol/L in men and <1.30mmol/L in women) was seen among 33.1% (95% confidence interval [CI], 32.9–33.3) of Asians versus 27.0% (95% CI, 26.5–27.5) of non-Asians (P<0.001). The prevalence of low HDL-C in the absence of other lipid abnormalities (isolated low HDL-C) was higher in Asians compared with non-Asians: 22.4% (95% CI, 22.2–22.5) versus 14.5% (95% CI, 14.1–14.9), respectively (P<0.001). During 6.8 years of follow-up, there were 574 coronary heart disease and 739 stroke events. There was an inverse relationship between low HDL-C with coronary heart disease in all individuals (hazard ratio, 1.57; 95% CI, 1.31–1.87). In Asians, isolated low levels of HDL-C were as strongly associated with coronary heart disease risk as low levels of HDL-C combined with other lipid abnormalities (hazard ratio, 1.67 [95% CI, 1.27–2.19] versus 1.63 [95% CI, 1.24–2.15], respectively). There was no association between low HDL-C and stroke risk in this population (hazard ratio, 0.95 [95% CI, 0.78 to 1.17] with nonisolated low HDL-C and 0.81 [95% CI, 0.67–1.00] with isolated low HDL-C). Conclusion:Isolated low HDL-C is a novel lipid phenotype that appears to be more prevalent among Asian populations, in whom it is associated with increased coronary risk. Further investigation into this type of dyslipidemia is warranted (Figs 1 and 2). Figure 1: A and B, Prevalence of lipid phenotypes in adult Asian populations (A; n=191 317) and adult populations from Australia and New Zealand (B; n=28 743). HDL indicates high-density lipoprotein; HDL-C, HDL cholesterol; LDL, low-density lipoprotein; and TG, triglycerides. (Reprinted from Huxley RR, for the Asia Pacific Cohort Studies Collaboration and the Obesity in Asia Collaboration. Isolated low levels of high-density lipoprotein cholesterol are associated with an increased risk of coronary heart disease: an individual participant data meta-analysis of 23 studies in the asia-pacific region. Circulation. 2011;124:2056-2064, Copyright 2011, with permission from American Heart Association, Inc.) Figure 2: Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for coronary heart disease associated with high-density lipoprotein cholesterol levels (HDL-C) by region (Asia vs Australia/New Zealand [ANZ]), sex, and smoking status (current vs not) from studies included in the Asia Pacific Cohort Studies Collaboration. Normal HDL-C means normal levels of HDL-C; isolated, isolated low levels of HDL-C; and low, low levels of HDL-C and high LDL-C and/or high triglycerides. The 3 groups are mutually exclusive. P for regional, sex, and smoking interaction=0.016, 0.04, and 0.95, respectively. (Reprinted from Huxley RR, for the Asia Pacific Cohort Studies Collaboration and the Obesity in Asia Collaboration. Isolated low levels of high-density lipoprotein cholesterol are associated with an increased risk of coronary heart disease: an individual participant data meta-analysis of 23 studies in the asia-pacific region.