HDL和冠心病.ppt

HDL and Coronary Heart Disease Epidemiology of CHD HDL-C Distribution in US Adults CHD Risk According to HDL-C LevelsFramingham Study CHD Risk According to Total-C/HDL-C RatioFramingham Study (Men) CHD Risk According to HDL-C LevelsProspective Cardiovascular Münster Study Low HDL-C Levels Increase CHD Risk Even When Total-C Is Normal (Framingham) Hypertriglyceridemia Increases CHD Risk in Patients with Low HDL-C LevelsProspective Cardiovascular Münster Study Frequency of Low HDL-C Compared With Other Risk Factors in Men With Premature CHD Cases Controls (n = 321) Risk factor (n = 601) Not adjusted Adjusted Cigarette smoking 29% 67%* — HDL-C ? 35 mg/dL 19% 63%* 57%* Hypertension (BP ? 150/90) 21% 41%* — LDL-C ? 160 mg/dL 26% 26% 34%* Diabetes mellitus 1% 12%* — Distribution of HDL-C Levels in Men With CHDVA-HIT Study Group HDL-C level Whites Blacks All subjects (mg/dL) (n = 2,891) (n = 572) (n = 8,578) 35 42% 20% 38% 35–40 25% 23% 25% 40 32% 57% 36% CHD Incidence Related to HDL-C Levels in Various Trials Population, Gender, and Ethnic Variability in HDL-C Levels Mean HDL-C level (mg/dL) Population Men Women United States (NHANES III)1 Whites 44 54 African-Americans 51 55 Turkey (Turkish Heart Study)2 37 42 Ethnic Variations in Lipid Parameters Insulin Resistance Atherosclerosis Study African- Non-Hispanic Americans Hispanics Whites P value n 462 (27%) 546 (34%) 612 (38%) 0.001 Total-C (mg/dL) 212.5 211.1 213.2 0.782 LDL-C (mg/dL) 143.8 139.4 140.7 0.410 HDL-C (mg/dL) 47.0 42.3 44.0 0.001 TG (mg/dL) 102.1 147.7 134.0 0.001 LDL size (?) 262.1 257.6 259.2 0.001 Changing Mortality Rates Over Time for CHD in Patients With and Without Diabetes Differences in CVD Risk Factors byDiabetes Status in Men and WomenThe Strong Heart Study Probability of Death From CHD in Patients With NIDDM and in Nondiabetic Patients,