Circulation:中年养生已来不及!追踪27年发现,青年人低密度脂蛋白胆固醇过高,心血管疾病死亡风险增加30%-90%

2018-09-11 奇点糕 奇点网

在这项研究中,研究人员共招募了36375名志愿者,年龄在36-48岁之间,中位年龄为42岁(44岁以下都是青年人,你们不要批评奇点糕顺便说一句,Circulation官方的报道直接用了“young”呢,多大胆~),随访26.8年,志愿者们均没有糖尿病和心血管疾病史,而且10年动脉粥样硬化性心血管疾病(ASCVD)风险<7.5%(10年ASCVD风险是根据性别、年龄、总胆固醇、高密度脂蛋白胆固醇等一

有一句话奇点糕听过很多次,叫“年轻就是资本”,这句话用来鼓励大家努力、敢于试错倒是很合适。然而呢,有很多人把它错误的应用到了其他地方,比如日常的生活习惯中,抽烟、喝酒、熬夜、饮食结构不合理还不爱运动,所以超重的、“三高”的青年同志比比皆是。

对于这些朋友,奇点糕想说:“你们清醒一点!”不要以为年纪不大,看起来身体健康就可以毫不节制的生活,在最近发表在美国心脏协会官方杂志Circulation上的研究中,德克萨斯州立大学西南医学中心的研究人员对超过3.6万名身体健康且血管疾病风险低的青年志愿者进行了长达27年的追踪随访,发现,如果他们的低密度脂蛋白胆固醇水平高于正常范围,那么血管疾病的死亡风险会增加30%-90%不等,其中冠心病的死亡风险更是有可能翻倍!

在这项研究中,研究人员共招募了36375名志愿者,年龄在36-48岁之间,中位年龄为42岁(44岁以下都是青年人,你们不要批评奇点糕顺便说一句,Circulation官方的报道直接用了“young”呢,多大胆~),随访26.8年,志愿者们均没有糖尿病和心血管疾病史,而且10年动脉粥样硬化性心血管疾病(ASCVD)风险<7.5%(10年ASCVD风险是根据性别、年龄、总胆固醇、高密度脂蛋白胆固醇等一系列风险因素作为参数计算出来的,<7.5%即为低风险人群)。

低密度脂蛋白胆固醇(LDL-C),嗯,这位也算是奇点糕们心血管疾病文章中的常客了,是导致动脉粥样硬化的“坏胆固醇”。

在这项研究中,研究人员将LDL-C<100mg/dL视为正常范围,作为分析中的对照组(注意了,参与研究的都是心血管疾病低风险人群,如果是高风险的话,应该控制在更低的范围内,如70mg/dL),另外四组分别为100-129mg/dL、130-159mg/dL、160-189mg/dL和≥190mg/dL。


不通过分组志愿者的年龄、抽烟人数、BMI和LDL-C水平等基本信息

研究人员首先用单变量分析模型进行了分析,也就是在不考虑其他风险因素的情况下,与LDL-C<100mg/dL的志愿者相比,100-129mg/dL、130-159mg/dL、160-189mg/dL和≥190mg/dL组志愿者心血管疾病死亡风险分别上升了40%、30%、90%和70%!

即使是在调整了性别、高密度脂蛋白胆固醇(HDL-C)、吸烟习惯、高血压和心血管疾病家族史这些因素后,LDL-C水平在100-129.9mg/dL、160-189.9mg/dL和≥190mg/dL这三个区间内依然与心血管疾病死亡有明显的关联,风险会上升30%-70%之多。


随着随访时间的增加,不同LDL-C区间内的志愿者心血管疾病死亡的百分比

如果单独看冠心病这个与LDL-C关系最密切的心血管疾病的话,那些LDL-C水平超过100mg/dL的志愿者风险就更高了,在调整了多个因素后,LDL-C在160-189mg/dL和≥190mg/dL范围内的志愿者冠心病死亡风险都翻倍了,分别增加了120%和100%!

从患者基本信息的统计表中我们可以看到,LDL-C水平超过160mg/dL的志愿者人数为6603,占全部志愿者的18.2%,也不算是少数了。

除了LDL-C,研究人员还以非HDL-C作为变量进行了分析。非HDL-C和LDL-C有什么区别呢?虽然我们通常认为总胆固醇就是HDL-C + LDL-C,但其实还有一种极低密度脂蛋白胆固醇(VLDL-C),它和LDL-C一样也会堆积在血管壁上,形成斑块。因此,非HD-L就是LDL-C和VLDL-C的总和。



虽然没有LDL-C应用的那么广泛,但是非HDL-C也被认为是可以衡量心血管疾病风险的一个指标,它的正常水平应该比LDL-C高30mg/dL。所以,在这次研究中,研究人员将非HDL-C<130mg/dL作为对照,发现当超过160mg/dL时,志愿者的心血管疾病死亡风险会上升30%-80%。

从这些数据可以看出,无论是LDL-C还是非HDL-C,160mg/dL都是一个明显的“分界值”,超过这个水平的志愿者的心血管疾病死亡风险会飞速增加。

研究人员还从全部志愿者中筛选出了10年ASCVD风险<5%的,对他们进行了同样的分析,结果与前面一致,LDL-C和非HDL-C的水平超过160mg/dL之后,心血管疾病死亡风险显着增加。

看来,这些表面健康的低风险青年人可真是既不“健康”又不低风险。研究开始的时候,志愿者还都处于青年时期,没有到达心血管疾病的高发年龄,但是这个时候过高的LDL-C水平依然会大幅增加他们的心血管疾病死亡风险,所以说,仗着青年力壮就不节制的生活是不行的。

研究人员也建议:“即使是低风险的人也应该采取生活方式干预,将LDL-C水平控制在100mg/dL以下,限制饱和脂肪的摄入、保持健康体重、不吸烟以及增加有氧运动,这些适用于每个年龄段的每一个人。”

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    2018-11-23 kafei

    学习了谢谢

    0

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    2018-12-07 zll0625
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    2018-09-13 tjdsyyzg

    所以说,降低LDL-C是硬道理!

    0

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    2018-09-11 惠映实验室

    学习了,谢谢分享。

    0

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