|编译服务：||心血管疾病防治||编译者：||张燕舞||编译时间：||May 22, 2018||浏 览 量：||1|
甘油三酯水平升高是心血管疾病事件的风险因素。 在一项对58,000名年龄在40-65岁，没有心血管疾病（CVD），糖尿病和基线时使用他汀类药物的丹麦人进行的人口研究中，估计了由甘油三酯水平升高导致的风险程度。 在基线甘油三酯水平≥264mg/ dL（3.0mmol / L）的患者中，估计10年内发生主要不良心血管事件（MACE）的风险开始接近具有升高的低密度脂蛋白胆固醇的患者的MACE风险， 达到开始他汀治疗的阈值。 我们目前推荐药物治疗以降低患有胰腺炎风险的患者甘油三酯（甘油三酯> 886 mg / dL [10.0 mmol / L]）。 目前还没有关于他汀类药物或其他药物治疗针对甘油三酯水平较低的患者用于预防MACE的研究。
Aims To identify individuals at high risk of atherosclerotic cardiovascular disease (ASCVD), who are not definite statin eligible according to the 2016 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines, based on high concentrations of plasma triglycerides.
Methods and results From the Copenhagen General Population Study (2003-2015) 58 547 individuals aged 40-65 and free of ASCVD, diabetes, and statin use at baseline were included. Of these, 14% were definite statin eligible, 7% were not eligible and had triglycerides ≥3.0 mmol/L (264 mg/dL), and 79% were not statin eligible and had triglycerides <3.0 mmol/L (264 mg/dL). During 456 057 person-years of follow-up, 1770 individuals experienced a major adverse cardiovascular event (MACE) and 734 experienced a myocardial infarction (MI). The cumulative incidences of MACE at age 70 were 8.1% (95% confidence interval 7.3-8.9%) and 14.6% (12.6-16.8%) in statin non-eligible individuals with triglycerides<3.0 mmol/L (264 mg/dL) and≥3.0 mmol/L (264 mg/dL), and 16.5% (14.0-19.3%) in statin eligible individuals. Corresponding cumulative incidences of MI were 3.0% (2.7-3.3%), 7.8% (6.4-9.5%), and 7.1% (5.9-8.4%), respectively. The estimated 10-year risks of MACE were 2.8% (2.6-3.0%) and 5.7% (4.9-6.6%) in statin non-eligible individuals with triglycerides<3.0 mmol/L (264 mg/dL) and≥3.0 mmol/L (264 mg/dL), and 7.6% (6.9-8.3%) in statin eligible individuals; the median age in these three groups were 51, 51, and 60 years, respectively. Corresponding risks of MI were 1.0% (0.9-1.1%), 3.0% (2.4-3.7%), and 3.3% (2.8-3.7%), respectively.
Conclusion Statin non-eligible individuals with triglycerides ≥3.0 mmol/L (264 mg/dL) had risk of ASCVD similar to statin eligible individuals, defined according to the 2016 ESC/EAS guidelines. This illustrates an unmet need for primary prevention, calling for expansion of guidelines on statin eligibility, and the potential for placebo-controlled randomized clinical trials in individuals with hypertriglyceridaemia.