HDL和冠心病课件.ppt

1、Slide SourceLipidsOnlineEpidemiology of CHDSlide SourceLipidsOnlineRF=risk factorsData from NHANES III,19881994HDL-C(mg/dL)3535 4545 60 60CHD0246810121416 2 RF,no CHDNo.of US adults(millions)Slide SourceLipidsOnline4.03.02.01.0254565HDL-C(mg/dL)CHD risk ratioKannel WB.Am J Cardiol 1983;52:9B12B.Copy

2、right 1983,with permission from Excerpta Medica Inc.2.01.004.0Slide SourceLipidsOnlineKannel WB.Am J Cardiol 1987;59:80A90A3.02.52.01.51.00.52.04.06.08.0 10.0 12.0Total-C/HDL-C ratioCHD risk ratio3.44.49.6Slide SourceLipidsOnline1103021020406080100120 55Incidenceper 1,000(in 6 years)HDL-C(mg/dL)Assm

3、ann G,ed.Lipid Metabolism Disorders and Coronary Heart Disease.Munich:MMV Medizin Verlag,1993186 events in 4,407 men(aged 4065 y)Slide SourceLipidsOnlineRisk of CHD by HDL-C and Total-C levels;aged 4883 yCastelli WP et al.JAMA 1986;256:2835283802468101214 40 4049 5059 60 5.0*LDL-C/HDL-C ratioInciden

4、ceper 1,000(in 6 years)TG 200 mg/dLTG 200 mg/dLSlide SourceLipidsOnline Cases Controls (n=321)Risk factor (n=601)Not adjusted AdjustedCigarette smoking29%67%*HDL-C 35 mg/dL19%63%*57%*Hypertension(BP 150/90)21%41%*LDL-C 160 mg/dL26%26%34%*Diabetes mellitus 1%12%*Significantly different from controls(

5、P 0.001)Genest JJ et al.Am J Cardiol 1991;67:11851189Slide SourceLipidsOnlineHDL-C level Whites BlacksAll subjects (mg/dL)(n=2,891)(n=572)(n=8,578)40 32%57%36%Rubins HB et al.Am J Cardiol 1995;75:1196120163%Slide SourceLipidsOnline95%confidence intervals(CIs)for adjusted proportional hazards regress

6、ion coefficients.FHS=Framingham Heart Study;LRCF=Lipid Research Clinics Prevalence Mortality Follow-up Study;CPPT=Lipid Research Clinics Coronary Primary Prevention Trial;MRFIT=Multiple Risk Factor Intervention TrialGordon DJ et al.Circulation 1989;79:815%change in risk per 1 mg/dL increment in HDL-

7、C0-2-4-6-8-10FHSLRCF CPPT MRFITFHSLRCFCHD incidenceMenWomenSlide SourceLipidsOnline Mean HDL-C level(mg/dL)Population MenWomenUnited States(NHANES III)1Whites4454African-Americans5155Turkey(Turkish Heart Study)237421.NHANES III,19881994(unpublished data)2.Mahley RW et al.J Lipid Res 1995;36:839859Sl

8、ide SourceLipidsOnline African-Non-HispanicAmericans Hispanics Whites P valuen462(27%)546(34%)612(38%)0.001Total-C(mg/dL)212.5211.1213.20.782LDL-C(mg/dL)143.8139.4140.70.410HDL-C(mg/dL)47.042.344.0 0.001TG(mg/dL)102.1147.7134.0 0.001LDL size()262.1257.6259.2 0.001Haffner SM et al.Arterioscler Thromb

9、 Vasc Biol 1999;19:22342240.Slide SourceLipidsOnlineSubjects aged 3574 yGu K et al.JAMA 1999;281:12911297177.414.24.26.82.47.61.9024681012141618-16.6%(P=0.46)+10.7%(P=0.76)-43.8%(P 0.001)-20.4%(P=0.12)Men(NHANES I,197175)Men(NHEFS,198284)Women(NHANES I,197175)Women(NHEFS,198284)DiabeticNondiabeticMo

10、rtality rate(%)per 1,000 person-yearsSlide SourceLipidsOnline-7.5*Men(n=1,846)Women(n=2,703)*P=0.0005;P=0.0120Adapted from Howard BV et al.Diabetes Care 1998;21:12581265-4.4-3.7-5.3-8-7-6-5-4-3-2-10HDL-C(mg/dL)LDL size()Differences between subjects with and without diabetesNative AmericansSlide Sour

11、ceLipidsOnlineKaplan-Meier estimatesHaffner SM et al.N Engl J Med 1998;339:229234.Copyright 1998,Massachusetts Medical Society.All rights reserved.012345678020406080100Nondiabetic subjects without prior MIDiabetic subjects without prior MINondiabetic subjects with prior MIDiabetic subjects with prio

12、r MIYearsSurvival(%)Slide SourceLipidsOnline280 pts with CHDTurner RC et al.BMJ 1998;316:8238281111.480.871.632.290.511.9300.51.01.52.02.5LDL-CHDL-CTG1st 2nd 3rd1st 2nd 3rd1st 2nd 3rdTertileTertileTertileEstimated hazard ratioP 0.001P 0.001P 0.001Slide SourceLipidsOnlineCoronary heart disease(n=280)

13、Position in modelVariable P value1stLDL-C0.00012ndHDL-C0.00013rdHemoglobin A1c0.00224thSystolic blood pressure0.00655thSmoking0.056Turner RC et al.BMJ 1998;316:823828Slide SourceLipidsOnline“Triglyceride concentration was a risk factor for coronary artery disease after adjustment for age and sex,but

14、 it was not an independent risk factor when the other variables were included in the model.”Turner RC et al.BMJ 1998;316:823828Slide SourceLipidsOnline Conversion status at follow-upDiabetes Normal(n=18)(n=490)P valueBody mass index(kg/m2)28.227.20.472TG(mmol/L)1.831.280.006HDL-C(mmol/L)1.141.280.04

15、5Systolic BP(mm Hg)116.8108.8 0.004Fasting glucose(mmol/L)5.285.000.032Fasting insulin(pmol/L)157810.006Haffner SM et al.JAMA 1990;263:28932898Slide SourceLipidsOnlinenLow HDL-C levels(40 mg/dL)occur in 4060%of CHD patients.nHDL-C values below 40 mg/dL are often associated with increased CHD risk ev

16、en if total cholesterol is below 200 mg/dL.nHypertriglyceridemia or elevated LDL-C levels greatly enhance CHD risk in patients with low HDL-C.nSmoking,hypertension,and diabetes mellitus also magnify CHD risk in lowHDL-C patients.Slide SourceLipidsOnline演讲完毕，谢谢观看！Thank you for reading!In order to facilitate learning and use,the content of this document can be modified,adjusted and printed at will after downloading.Welcome to download!汇报人：XXX 汇报日期：20XX年10月10日