HDL和冠心病课件

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Slide Source,LipidsOnline,HDL and Coronary Heart Disease,Epidemiology of CHD,HDL and Coronary Heart Disease,HDL-C Distribution in US Adults,RF=risk factors,Data from NHANES III,19881994,HDL-C(mg/dL),35,35 45,45 60,60,CHD,0,2,4,6,8,10,12,14,16,2 RF,no CHD,No.of US adults(millions),HDL-C Distribution in US Adult,CHD Risk According to HDL-C Levels,Framingham Study,4.0,3.0,2.0,1.0,25,45,65,HDL-C(mg/dL),CHD risk ratio,Kannel WB.,Am J Cardiol,1983;52:9B12B.,Copyright 1983,with permission from Excerpta Medica Inc.,2.0,1.0,0,4.0,CHD Risk According to HDL-C Le,CHD Risk According to Total-C/HDL-C Ratio,Framingham Study(Men),Kannel WB.,Am J Cardiol,1987;59:80A90A,3.0,2.5,2.0,1.5,1.0,0.5,2.0,4.0,6.0,8.0,10.0,12.0,Total-C/HDL-C ratio,CHD risk ratio,3.4,4.4,9.6,CHD Risk According to Total-C/,CHD Risk According to HDL-C Levels,Prospective Cardiovascular Mnster Study,110,30,21,0,20,40,60,80,100,120,55,Incidence,per 1,000(in 6 years),HDL-C(mg/dL),Assmann G,ed.,Lipid Metabolism Disorders and Coronary Heart Disease.,Munich:MMV Medizin Verlag,1993,186 events in 4,407 men(aged 4065 y),CHD Risk According to HDL-C Le,Low HDL-C Levels Increase CHD Risk Even When Total-C Is Normal(Framingham),Risk of CHD by HDL-C and Total-C levels;aged 4883 y,Castelli WP et al.,JAMA,1986;256:28352838,0,2,4,6,8,10,12,14,40,4049,5059,60,5.0,*,LDL-C/HDL-C ratio,Incidence,per 1,000(in 6 years),TG 200 mg/dL,TG,200 mg/dL,Hypertriglyceridemia Increases,Frequency of Low HDL-C Compared With Other Risk Factors in Men With Premature CHD,Cases,Controls (n=321),Risk factor,(n=601),Not adjustedAdjusted,Cigarette 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(,P,0.001),Genest JJ et al.,Am J Cardiol,1991;67:11851189,Frequency of Low HDL-C Compare,Distribution of HDL-C Levels in Men With CHD,VA-HIT Study Group,HDL-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;75:11961201,63%,Distribution of HDL-C Levels i,CHD Incidence Related to HDL-C Levels in Various Trials,95%confidence intervals(CIs)for adjusted proportional hazards regression 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 Trial,Gordon DJ et al.,Circulation,1989;79:815,%,change in risk per 1 mg/dL increment in HDL-C,0,-2,-4,-6,-8,-10,FHS,LRCF,CPPT,MRFIT,FHS,LRCF,CHD incidence,Men,Women,CHD Incidence Related to HDL-C,Population,Gender,and Ethnic Variability in HDL-C Levels,Mean HDL-C level(mg/dL),Population MenWomen,United States(NHANES III),1,Whites4454,African-Americans5155,Turkey(Turkish Heart Study),2,3742,1.NHANES III,19881994(unpublished data),2.Mahley RW et al.,J Lipid Res,1995;36:839859,Population,Gender,and Ethnic,Ethnic Variations in Lipid Parameters,Insulin Resistance Atherosclerosis Study,African-Non-Hispanic,Americans Hispanics Whites,P,value,n462(27%)546(34%)612(38%)0.001,Total-C(mg/dL)212.5211.1213.20.782,LDL-C(mg/dL)143.8139.4140.70.410,HDL-C(mg/dL)47.042.344.0 0.001,TG(mg/dL)102.1147.7134.0 0.001,LDL size()262.1257.6259.2 0.001,Haffner SM et al.,Arterioscler Thromb Vasc Biol,1999;19:22342240.,Ethnic Variations in Lipid Par,Changing Mortality Rates Over Time for CHD in Patients With and Without Diabetes,Subjects aged 3574 y,Gu K et al.,JAMA,1999;281:12911297,17,7.4,14.2,4.2,6.8,2.4,7.6,1.9,0,2,4,6,8,10,12,14,16,18,-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),Diabetic,Nondiabetic,Mortality rate(%),per 1,000 person-years,Changing Mortality Rates Over,Differences in CVD Risk Factors byDiabetes Status in Men and Women,The Strong Heart Study,-7.5*,Men(n=1,846),Women(n=2,703),*,P,=0.0005;,P,=0.0120,Adapted from Howard BV et al.,Diabetes Care,1998;21:12581265,-4.4,-3.7,-5.3,-8,-7,-6,-5,-4,-3,-2,-1,0,HDL-C,(mg/dL),LDL size,(),Differences between subjects with and without diabetes,Native Americans,Differences in CVD Risk Factor,Probability of Death From CHD in Patients With NIDDM and in Nondiabetic Patients,With and Without Prior MI,Kaplan-Meier estimates,Haffner SM et al.,N Engl J Med,1998;339:229234.,Copyright 1998,Massachusetts Medical Society.All rights reserved.,0,1,2,3,4,5,6,7,8,0,20,40,60,80,100,Nondiabetic subjects without prior MI,Diabetic subjects without prior MI,Nondiabetic subjects with prior MI,Diabetic subjects with prior MI,Years,Survival(%),Probability of Death From CHD,Potential Risk Factors for CHD in 2,693 White Patients With NIDDM,United Kingdom Prospective Diabetes Study,280 pts with CHD,Turner RC et al.,BMJ,1998;316:823828,1,1,1,1.48,0.87,1.63,2.29,0.51,1.93,0,0.5,1.0,1.5,2.0,2.5,LDL-C,HDL-C,TG,1st,2nd,3rd,1st,2nd,3rd,1st,