使用某些脂质措施在预测冠心病方面并不更有效

据一项研究，脂质测量脂肪蛋白（APO）B：APO A-I比不是包括总胆固醇和HDL-C的冠心病风险的更好预测因子。

冠心病（CHD）预防的当前风险预测仪器和指南强调使用低密度脂蛋白胆固醇（LDL-C），总胆固醇或两者的CHD风险评估。But in recent years, some evidence has suggested that higher apo B (the primary protein component of LDL) and lower apo A-I (the primary protein component of high-density lipoprotein [HDL]) levels play a role in the development of CHD, and that these measures might be superior to traditional lipid measures for CHD risk prediction, according to background information in the article.

Erik Ingelsson, M.D., Ph.D., of the Framingham Study, Boston University School of Medicine, Framingham, Mass., and colleagues evaluated whether apolipoproteins (the protein component of serum lipoproteins) could be used instead of traditional lipid measures for CHD risk prediction in a large group of men and women who were part of the Framingham Offspring Study. The researchers evaluated serum total cholesterol, HDL cholesterol (HDL-C), LDL-C, non–HDL-C, apo A-I and apo B, and three lipid ratios (total cholesterol:HDL-C, LDL-C:HDL-C, and apo B:apo A-I) in 3,322 middle-aged white participants who were examined between 1987-1991 and were without cardiovascular disease. Fifty-three percent of the participants were women. After a median (midpoint) follow-up of 15.0 years, 291 participants, 198 of whom were men, developed CHD.

“我们的主要发现是3倍。首先，即使APO B：APO A-I比率在两种性别的CHD风险预测和模型性能措施方面已经完全良好，与其他脂质变量相比的差异很小，统计学不显着。与脂质比相比，非HDL-C比较较少。其次，当评估CHD风险重新分类时，总胆固醇：HDL-C比与APO B：APO A-I比例提供的净重分配改善的差异在两性中小而统计学。第三，当添加到掺入框架风险评分组分的模型中，APO B：A APO A-I比没有显着与任何性别的CHD发病率显着相关，包括总胆固醇：HDL-C.作者写道，该观察结果表明APO B：A-I比率不提供与既定的CHD危险因素为具有传统脂质措施的CHD危险因素的增量预测效用。“

“鉴于各种脂质比率的总体平等性能，其他因素对于指导应用于CHD风险预测的脂质措施的选择是至关重要的。这些因素包括分析的成本和可用性，医疗保健专业人员和公众用于解释载脂蛋白措施的有效测量的可能性，在非特快样品中获得有效测量的风险预测或接受脂质降低治疗的患者，以及适当的可用性治疗切口和降低水平效益的临床证据（基于随机，受控临床试验）。然而，关于测试性能特征，我们的数据不支持在常规获得传统的脂质测量时在临床实践中测量APO B或APO A-I的需要，“研究人员得出结论。

资料来源：Jama和Archives期刊

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