小柯机器人

丹麦哥本哈根大学医院Børge Grønne Nordestgaard团队研究了70-100岁人群低密度脂蛋白（LDL）胆固醇升高与心肌梗死和动脉粥样硬化性心血管疾病风险增加之间的相关性。2020年11月10日，该研究发表在《柳叶刀》杂志上。

历史研究发现，在70岁以上的患者中，LDL胆固醇升高与心肌梗死和动脉粥样硬化性心血管疾病的风险增加无关。

为了在当代70-100岁的人群中检验这一假设，研究组招募基线检查时没有动脉粥样硬化性心血管疾病或糖尿病，也没有服用他汀类药物的参与者（年龄在20-100岁之间），均接受LDL胆固醇检测。研究组计算了心肌梗死和动脉粥样硬化性心血管疾病的风险比（HRs）和绝对事件率，并估计了5年内预防一次事件所需治疗（NNT）的数量。

2003年11月25日至2015年2月17日，研究组共招募了91131名参与者，平均随访7.7年后，1515名首次发生心肌梗死，3389名患有动脉粥样硬化性心血管疾病。LDL胆固醇每增加1.0 mmol/L，心肌梗死的风险比为1.34，在所有年龄组，特别是70-100岁的人群中，心肌梗死的风险均增加了。LDL胆固醇每增加1.0 mmol/L，动脉粥样硬化性心血管疾病的风险比为1.16，在所有年龄组，特别是70-100岁年龄组中风险显著增加。

在80-100岁和70-79岁的人群中，LDL胆固醇水平与低于3.0 mmol/L相比，高于5.0 mmol/L时，心肌梗死的风险显著增加，风险比分别为2.99和1.82。LDL胆固醇水平每升高1.0 mmol/L，每1000人年心肌梗死和动脉粥样硬化性心血管疾病事件的发生率在70-100岁的人群中最高，年纪越轻，事件数量越少。如果所有人都服用中等强度的他汀类药物，则5年内预防一次心肌梗死或动脉粥样硬化性心血管疾病事件的NNT在年龄为70-100岁的人群众最低，但随着年龄的增长而增加。

总之，70-100岁LDL胆固醇升高的人群患心肌梗死和动脉粥样硬化性心血管疾病的绝对风险最高，5年内可预防一次事件的估计NNT最低。

附：英文原文

Title: Elevated LDL cholesterol and increased risk of myocardial infarction and atherosclerotic cardiovascular disease in individuals aged 70–100 years: a contemporary primary prevention cohort

Author: Martin Bdtker Mortensen, Brge Grnne Nordestgaard

Issue&Volume: 2020-11-10

Abstract:

Background

Findings of historical studies suggest that elevated LDL cholesterol is not associated with increased risk of myocardial infarction and atherosclerotic cardiovascular disease in patients older than 70 years. We aimed to test this hypothesis in a contemporary population of individuals aged 70–100 years.

Methods

We included in our analysis individuals (aged 20–100 years) from the Copenhagen General Population Study (CGPS) who did not have atherosclerotic cardiovascular disease or diabetes at baseline and who were not taking statins. Standard hospital assays were used to measure LDL cholesterol. We calculated hazard ratios (HRs) and absolute event rates for myocardial infarction and atherosclerotic cardiovascular disease, and we estimated the number needed to treat (NNT) in 5 years to prevent one event.

Findings

Between Nov 25, 2003, and Feb 17, 2015, 91131 individuals were enrolled in CGPS. During mean 7·7 (SD 3·2) years of follow-up (to Dec 7, 2018), 1515 individuals had a first myocardial infarction and 3389 had atherosclerotic cardiovascular disease. Risk of myocardial infarction per 1·0 mmol/L increase in LDL cholesterol was augmented for the overall population (HR 1·34, 95% CI 1·27–1·41) and was amplified for all age groups, particularly those aged 70–100 years. Risk of atherosclerotic cardiovascular disease was also raised per 1·0 mmol/L increase in LDL cholesterol overall (HR 1·16, 95% CI 1·12–1·21) and in all age groups, particularly those aged 70–100 years. Risk of myocardial infarction was also increased with a 5·0 mmol/L or higher LDL cholesterol (ie, possible familial hypercholesterolaemia) versus less than 3·0 mmol/L in individuals aged 80–100 years (HR 2·99, 95% CI 1·71–5·23) and in those aged 70–79 years (1·82, 1·20–2·77). Myocardial infarction and atherosclerotic cardiovascular disease events per 1000 person-years for every 1·0 mmol/L increase in LDL cholesterol were highest in individuals aged 70–100 years, with number of events lower with younger age. The NNT in 5 years to prevent one myocardial infarction or atherosclerotic cardiovascular disease event if all people were given a moderate-intensity statin was lowest for individuals aged 70–100 years, with the NNT increasing with younger age.

Interpretation

In a contemporary primary prevention cohort, people aged 70–100 years with elevated LDL cholesterol had the highest absolute risk of myocardial infarction and atherosclerotic cardiovascular disease and the lowest estimated NNT in 5 years to prevent one event. Our data are important for preventive strategies aimed at reducing the burden of myocardial infarction and atherosclerotic cardiovascular disease in the growing population aged 70–100 years.

DOI: 10.1016/S0140-6736(20)32233-9

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32233-9/fulltext

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