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JACC：空腹甘油三酯可作为他汀治疗后CVD的预测指标

2015-06-04 大鹏 译 医学论坛网

甘油三酯他汀CVD预测指标
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近期Gregory Schwartz博士研究团队完成了两个主要临床试验的数据析因分析。研究结果显示，对于服用他汀的急性冠脉综合征(ACS)患者，空腹甘油三酯水平升高与患者心血管事件风险率升高存在显著相关性，而且这种相关性在短期随访与长期随访过程中均得到了证实。研究论文发表于《美国心脏病学会杂志》。 研究者在此次研究中分析了MIRACL试验及dal-

近期Gregory Schwartz博士研究团队完成了两个主要临床试验的数据析因分析。研究结果显示，对于服用他汀的急性冠脉综合征(ACS)患者，空腹甘油三酯水平升高与患者心血管事件风险率升高存在显著相关性，而且这种相关性在短期随访与长期随访过程中均得到了证实。研究论文发表于《美国心脏病学会杂志》。

研究者在此次研究中分析了MIRACL试验及dal-OUTCOMES试验的数据。MIRACL试验与dal-OUTCOMES试验分别有1501例及15817服用大剂量他汀的ACS患者。MIRACL试验观察的是短期效果(16周)，而dal-OUTCOMES试验为长期效果(31个月)。

研究者发现，无论是短期还是长期，甘油三酯升高10mg/dL与心血管事件风险率提高1.4%相关。与低甘油三酯(≤135mg/dL)组患者相比，高甘油三酯(>190mg/dL)患者的心血管事件风险率升高50%。

需要指出的是，dal-OUTCOMES是一项关于服用他汀的ACS患者加用胆固醇酯转移蛋白(CETP)抑制剂达塞曲匹治疗效果的3期临床试验。虽然试验主要观察指标不理想，但其数据显示，空腹甘油三酯基线水平较高(>175mg/dL)的患者心血管事件风险率比空腹甘油三酯低水平患者(≤80mg/dL)升高61%。

如何降低甘油三酯?

该研究临床意义更多的是提醒临床医生注意给予甘油三酯水平不断升高的患者适时的生活方式干预，“如果患者甘油三酯不断升高，医生或考虑向患者推荐服用鱼油。”同样的观点也出现在对该研究的编者按中：轻度减重可以降低20%的甘油三酯水平，而中高强度运动可降低20%至30%甘油三酯水平。

除了鱼油，研究者还提到了apoC3(具有清除甘油三酯功能)的反义寡核苷酸干预设想。有研究证实apoC3罕见突变个体甘油三酯水平及心血管事件风险均降低。

研究者表示，尽管多因素分析暂时无法证明甘油三酯与心血管事件存在因果关系，但综合MIRACL试验及dal-OUTCOMES试验的数据提示williamhill asia 两者很可能存在因果关系，或许靶向降低富含甘油三酯的脂蛋白药物真的可以控制心血管事件风险率。

原始出处：

Michael O'Riordan.Fasting Triglycerides Predict CVD Risk in Statin-Treated Patients.MedScape, May 29, 2015.

原始出处：

Michael O'Riordan.Fasting Triglycerides Predict CVD Risk in Statin-Treated Patients. MedScape, May 29, 2015.

Schwartz GG, Abt M, Bao W, et al. Fasting triglycerides predict recurrent ischemic events in patients with acute coronary syndrome treated with statins. J Am Coll Cardiol 2015; 65:2267-2275. Abstract

Joshi PH, Martin SS, Blumenthal RS. The remnants of residual risk. J Am Coll Cardiol 2015; 65:2276-2278. Editorial

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1853355, encodeId=674818533559a, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Thu Sep 03 14:11:00 CST 2015, time=2015-09-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=26586, encodeId=f713265862e, content=(⊙o⊙)…, beContent=null, objectType=article, channel=null, level=null, likeNumber=140, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12a31627589, createdName=18619c0a62m, createdTime=Tue Jun 09 17:42:00 CST 2015, time=2015-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=26256, encodeId=a275262564c, content=很可能存在因果关系？, beContent=null, objectType=article, channel=null, level=null, likeNumber=188, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150830/IMG55E294026A9942981.jpg, createdBy=fa351627501, createdName=惜言, createdTime=Mon Jun 08 08:10:00 CST 2015, time=2015-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1325045, encodeId=81341325045da, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Sat Jun 06 00:11:00 CST 2015, time=2015-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1406989, encodeId=19b01406989f3, content=<a href='/topic/show?id=fa7c100231a5' target=_blank style='color:#2F92EE;'>#预测指标#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100231, encryptionId=fa7c100231a5, topicName=预测指标)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=10c72588657, createdName=anminleiryan, createdTime=Sat Jun 06 00:11:00 CST 2015, time=2015-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=26035, encodeId=cfb326035d3, content=甘油三脂的影响因素太多，可靠性存疑, beContent=null, objectType=article, channel=null, level=null, likeNumber=130, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=96871613250, createdName=medcardio, createdTime=Fri Jun 05 08:08:00 CST 2015, time=2015-06-05, status=1, ipAttribution=)]
    2015-09-03 hbwxf

    #JACC#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1853355, encodeId=674818533559a, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Thu Sep 03 14:11:00 CST 2015, time=2015-09-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=26586, encodeId=f713265862e, content=(⊙o⊙)…, beContent=null, objectType=article, channel=null, level=null, likeNumber=140, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12a31627589, createdName=18619c0a62m, createdTime=Tue Jun 09 17:42:00 CST 2015, time=2015-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=26256, encodeId=a275262564c, content=很可能存在因果关系？, beContent=null, objectType=article, channel=null, level=null, likeNumber=188, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150830/IMG55E294026A9942981.jpg, createdBy=fa351627501, createdName=惜言, createdTime=Mon Jun 08 08:10:00 CST 2015, time=2015-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1325045, encodeId=81341325045da, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Sat Jun 06 00:11:00 CST 2015, time=2015-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1406989, encodeId=19b01406989f3, content=<a href='/topic/show?id=fa7c100231a5' target=_blank style='color:#2F92EE;'>#预测指标#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100231, encryptionId=fa7c100231a5, topicName=预测指标)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=10c72588657, createdName=anminleiryan, createdTime=Sat Jun 06 00:11:00 CST 2015, time=2015-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=26035, encodeId=cfb326035d3, content=甘油三脂的影响因素太多，可靠性存疑, beContent=null, objectType=article, channel=null, level=null, likeNumber=130, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=96871613250, createdName=medcardio, createdTime=Fri Jun 05 08:08:00 CST 2015, time=2015-06-05, status=1, ipAttribution=)]
    2015-06-09 18619c0a62m

    (⊙o⊙)…

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1853355, encodeId=674818533559a, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Thu Sep 03 14:11:00 CST 2015, time=2015-09-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=26586, encodeId=f713265862e, content=(⊙o⊙)…, beContent=null, objectType=article, channel=null, level=null, likeNumber=140, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12a31627589, createdName=18619c0a62m, createdTime=Tue Jun 09 17:42:00 CST 2015, time=2015-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=26256, encodeId=a275262564c, content=很可能存在因果关系？, beContent=null, objectType=article, channel=null, level=null, likeNumber=188, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150830/IMG55E294026A9942981.jpg, createdBy=fa351627501, createdName=惜言, createdTime=Mon Jun 08 08:10:00 CST 2015, time=2015-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1325045, encodeId=81341325045da, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Sat Jun 06 00:11:00 CST 2015, time=2015-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1406989, encodeId=19b01406989f3, content=<a href='/topic/show?id=fa7c100231a5' target=_blank style='color:#2F92EE;'>#预测指标#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100231, encryptionId=fa7c100231a5, topicName=预测指标)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=10c72588657, createdName=anminleiryan, createdTime=Sat Jun 06 00:11:00 CST 2015, time=2015-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=26035, encodeId=cfb326035d3, content=甘油三脂的影响因素太多，可靠性存疑, beContent=null, objectType=article, channel=null, level=null, likeNumber=130, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=96871613250, createdName=medcardio, createdTime=Fri Jun 05 08:08:00 CST 2015, time=2015-06-05, status=1, ipAttribution=)]
    2015-06-08 惜言

    很可能存在因果关系？

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1853355, encodeId=674818533559a, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Thu Sep 03 14:11:00 CST 2015, time=2015-09-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=26586, encodeId=f713265862e, content=(⊙o⊙)…, beContent=null, objectType=article, channel=null, level=null, likeNumber=140, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12a31627589, createdName=18619c0a62m, createdTime=Tue Jun 09 17:42:00 CST 2015, time=2015-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=26256, encodeId=a275262564c, content=很可能存在因果关系？, beContent=null, objectType=article, channel=null, level=null, likeNumber=188, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150830/IMG55E294026A9942981.jpg, createdBy=fa351627501, createdName=惜言, createdTime=Mon Jun 08 08:10:00 CST 2015, time=2015-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1325045, encodeId=81341325045da, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Sat Jun 06 00:11:00 CST 2015, time=2015-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1406989, encodeId=19b01406989f3, content=<a href='/topic/show?id=fa7c100231a5' target=_blank style='color:#2F92EE;'>#预测指标#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100231, encryptionId=fa7c100231a5, topicName=预测指标)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=10c72588657, createdName=anminleiryan, createdTime=Sat Jun 06 00:11:00 CST 2015, time=2015-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=26035, encodeId=cfb326035d3, content=甘油三脂的影响因素太多，可靠性存疑, beContent=null, objectType=article, channel=null, level=null, likeNumber=130, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=96871613250, createdName=medcardio, createdTime=Fri Jun 05 08:08:00 CST 2015, time=2015-06-05, status=1, ipAttribution=)]
    2015-06-06 12498568m50暂无昵称

    #ACC#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1853355, encodeId=674818533559a, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Thu Sep 03 14:11:00 CST 2015, time=2015-09-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=26586, encodeId=f713265862e, content=(⊙o⊙)…, beContent=null, objectType=article, channel=null, level=null, likeNumber=140, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12a31627589, createdName=18619c0a62m, createdTime=Tue Jun 09 17:42:00 CST 2015, time=2015-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=26256, encodeId=a275262564c, content=很可能存在因果关系？, beContent=null, objectType=article, channel=null, level=null, likeNumber=188, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150830/IMG55E294026A9942981.jpg, createdBy=fa351627501, createdName=惜言, createdTime=Mon Jun 08 08:10:00 CST 2015, time=2015-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1325045, encodeId=81341325045da, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Sat Jun 06 00:11:00 CST 2015, time=2015-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1406989, encodeId=19b01406989f3, content=<a href='/topic/show?id=fa7c100231a5' target=_blank style='color:#2F92EE;'>#预测指标#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100231, encryptionId=fa7c100231a5, topicName=预测指标)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=10c72588657, createdName=anminleiryan, createdTime=Sat Jun 06 00:11:00 CST 2015, time=2015-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=26035, encodeId=cfb326035d3, content=甘油三脂的影响因素太多，可靠性存疑, beContent=null, objectType=article, channel=null, level=null, likeNumber=130, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=96871613250, createdName=medcardio, createdTime=Fri Jun 05 08:08:00 CST 2015, time=2015-06-05, status=1, ipAttribution=)]
    2015-06-06 anminleiryan

    #预测指标#

    0

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    2015-06-05 medcardio

    甘油三脂的影响因素太多，可靠性存疑

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