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“好胆固醇”走下神坛又获新证:HDL-C高于60 mg/dl,不良心血管事件风险约增50%

2018-08-31 朱柳媛 中国循环杂志

近年来,陆续有不少研究质疑高密度脂蛋白胆固醇(HDL-C)“好胆固醇”的美誉。以往认为,HDL-C水平高有益于心血管健康,但近年多项研究显示,HDL-C水平太高并不是什么好事,它与总胆固醇、低密度脂蛋白胆固醇等“坏胆固醇”一样,也增加心脏病和死亡风险。

近年来,陆续有不少研究质疑高密度脂蛋白胆固醇(HDL-C)“好胆固醇”的美誉。以往认为,HDL-C水平高有益于血管健康,但近年多项研究显示,HDL-C水平太高并不是什么好事,它与总胆固醇、低密度脂蛋白胆固醇等“坏胆固醇”一样,也增加心脏病和死亡风险。

这不,在近日欧洲心脏病学会(ESC)年会上公布的一项最新研究又提供了新的证据。

该研究显示,HDL-C水平处于41~60 mg/dl(1.06~1.55 mmol/L)时死亡和心肌梗死风险最低,HDL-C超过60 mg/dl时风险增加近50%。

当然,HDL-C水平太低了也增加不良血管事件风险。以HDL-C水平 50 mg/dl作为参考,HDL-C水平<30 mg/dl时全因死亡、心血管死亡和非致死性心肌梗死风险增加62%。

研究者指出,“我们的研究结果很重要,这为‘极高水平HDL-C可能没有保护作用’又增添了证据,而且与其他类似研究不同的是,该研究的对象以心脏病患者为主。”

关于高HDL-C水平增加不良心血管事件风险的原因,目前并不十分清楚。有研究人员推断,极高水平HDL-C可能代表HDL-C功能失调,从而促使心血管疾病发生。

纳入5965例受试者,其中绝大多数有心血管病,平均年龄63岁。中位随访3.9年期间,13%的受试者因心血管病死亡或发生非致死性心肌梗死

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