Total cholesterol to HDL cholesterol ratio (TC/HDL) is an important prognostic factor for CVD. This study used restricted cubic spline modeling to investigate the dose-response associations between TC/HDL and both CVD hospitalization and CVD rehospitalization in two independent prospective cohorts. The East Cambridgeshire and Fenland cohort includes 4,704 patients with T2D from 18 general practices in Cambridgeshire. The Randomized controlled trial of Peer Support In type 2 Diabetes cohort comprises 1,121 patients with T2D with posttrial follow-up data. TC/HDL and other demographic and clinical measurements were measured at baseline. Outcomes were CVD hospitalization over 2 years and CVD rehospitalization after 90 days of the prior CVD hospitalization. Modeling showed nonlinear relationships between TC/HDL and risks of CVD hospitalization and rehospitalization consistently in both cohorts (all P < 0.001 for linear tests). The lowest risks of CVD hospitalization and rehospitalization were consistently found for TC/HDL at 2.8 (95% CI: 2.6-3.0) in both cohorts and both overall and by gender. This is lower than the current lipid control target, 4.0 of TC/HDL. Reducing the TC/HDL target to 2.8 would include a further 33-44% patients with TC/HDL in the 2.8-4.0 range. Studies are required to assess the effectiveness and cost-effectiveness of the earlier introduction of, and more intensive, lipid-lowering treatment needed to achieve this new lower TC/HDL target.

译文

:总胆固醇与HDL胆固醇之比(TC / HDL)是CVD的重要预后因素。这项研究使用限制性三次样条曲线模型研究了两个独立的前瞻性队列中TC / HDL与CVD住院和CVD再住院之间的剂量反应关联。东剑桥郡和芬兰德队列包括来自剑桥郡18个普通科的4,704例T2D患者。同伴支持在2型糖尿病队列中的随机对照试验包括1,121例T2D患者,并提供了随访数据。 TC / HDL以及其他人口统计学和临床​​测量均在基线进行。结果是2年内进行CVD住院治疗,以及先前CVD住院90天后进行CVD再住院治疗。建模显示,在两个队列中,TC / HDL与CVD住院和再次住院的风险之间始终存在非线性关系(对于线性测试,所有P <0.001)。 TC / HDL在人群,总体和性别方面均始终为2.8(95%CI:2.6-3.0),发生CVD住院和再次住院的风险最低。这低于当前的脂质控制目标TC / HDL的4.0。将TC / HDL指标降低到2.8将进一步使TC / HDL在2.8-4.0范围内的患者占33-44%。需要进行研究以评估为实现这一新的较低TC / HDL目标而需要的早期引入和更深入的降脂治疗的有效性和成本效益。

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