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期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2024.4819

摘要内容如下：

重要性

非高密度脂蛋白胆固醇（non-HDL-C；脂质相关心血管风险的推荐指标）升高在儿童中很常见，并会增加成人心血管疾病（CVD）的风险。儿童期升高的非HDL-C水平在成年期的消退是否与临床CVD事件风险的降低相关尚不清楚。

目的

研究儿童期和成年期之间非HDL-C状态与偶发CVD事件的关系。

设计、设置和参与者

来自美国和芬兰的6个前瞻性儿童队列（基线平均年龄为10.7岁）的个体参与者数据。招募工作于1970年至1996年进行，最后一次后续行动于2019年进行。

曝光

根据临床指南推荐的血脂异常临界值，儿童（3-19岁）和成人（20-40岁）非HDL-C年龄和性别特异性Z评分和分类。

主要成果和措施

由医疗记录判定的致命性和非致命性心血管疾病事件。

结果

在40岁以后平均8.9年的随访中，5121名参与者中发生了147起心血管疾病事件（60%为女性；15%黑色）。儿童和成人非HDL-C水平均与CVD事件风险增加相关（Z评分增加1个单位的风险比[HR]分别为1.42[95%CI，1.18-1.70]和1.50[95%CI，1.26-1.78]），但校正成人水平后，儿童非HDL-C的相关性降低（HR，1.12[95%CI，0.89-1.41]）。一项补充分析显示，儿童期非HDL-C水平以及儿童期和成年期之间的变化与结果独立相关，这表明从预防的角度来看，儿童期非HDL-C水平和成年期的变化都是有益的。与儿童期和成年期非HDL-C水平保持在指南推荐范围内的受试者相比，从儿童期到成年期发生非HDL-C血脂异常的受试者和持续性血脂异常的受试者发生CVD事件的风险增加（HR分别为2.17[95%CI，1.00-4.69]和5.17[95%CI，2.80-9.56]）。儿童期非高密度脂蛋白胆固醇（non-HDL-C）血脂异常但成年期非高密度脂蛋白胆固醇（non-HDL-C）水平在指南推荐范围内的个体，其风险并未显著增加（HR，1.13[95%CI，0.50-2.56]）。

结论和相关性

从儿童期到成年期持续存在非HDL-C血脂异常的个体发生CVD事件的风险增加，但那些血脂异常的非HDL-C水平在成年期消失的个体与从未发生血脂异常的个体具有相似的风险。这些研究结果表明，预防和降低儿童非HDL-C水平升高的干预措施可能有助于预防早发性心血管疾病。

英文原文如下：

Abstracts

Importance  Elevated non-high-density lipoprotein cholesterol (non-HDL-C; a recommended measure of lipid-related cardiovascular risk) is common in children and increases risk of adult cardiovascular disease (CVD). Whether resolution of elevated childhood non-HDL-C levels by adulthood is associated with reduced risk of clinical CVD events is unknown.

Objective  To examine the associations of non-HDL-C status between childhood and adulthood with incident CVD events.

Design, Setting, and Participants  Individual participant data from 6 prospective cohorts of children (mean age at baseline, 10.7 years) in the US and Finland. Recruitment took place between 1970 and 1996, with a final follow-up in 2019.

Exposures  Child (age 3-19 years) and adult (age 20-40 years) non-HDL-C age- and sex-specific z scores and categories according to clinical guideline-recommended cutoffs for dyslipidemia.

Main Outcomes and Measures  Incident fatal and nonfatal CVD events adjudicated by medical records.

Results  Over a mean length of follow-up of 8.9 years after age 40 years, 147 CVD events occurred among 5121 participants (60% women; 15% Black). Both childhood and adult non-HDL-C levels were associated with increased risk of CVD events (hazard ratio [HR], 1.42 [95% CI, 1.18-1.70] and HR, 1.50 [95% CI, 1.26-1.78] for a 1-unit increase in z score, respectively), but the association for childhood non-HDL-C was reduced when adjusted for adult levels (HR, 1.12 [95% CI, 0.89-1.41]). A complementary analysis showed that both childhood non-HDL-C levels and the change between childhood and adulthood were independently associated with the outcome, suggesting that from a preventive perspective, both childhood non-HDL-C levels and the change into adulthood are informative. Compared with those whose non-HDL-C levels remained within the guideline-recommended range in childhood and adulthood, participants who had incident non-HDL-C dyslipidemia from childhood to adulthood and those with persistent dyslipidemia had increased risks of CVD events (HR, 2.17 [95% CI, 1.00-4.69] and HR, 5.17 [95% CI, 2.80-9.56], respectively). Individuals who had dyslipidemic non-HDL-C in childhood but whose non-HDL-C levels were within the guideline-recommended range in adulthood did not have a significantly increased risk (HR, 1.13 [95% CI, 0.50-2.56]).

Conclusions and Relevance  Individuals with persistent non-HDL-C dyslipidemia from childhood to adulthood had an increased risk of CVD events, but those in whom dyslipidemic non-HDL-C levels resolve by adulthood have similar risk to individuals who were never dyslipidemic. These findings suggest that interventions to prevent and reduce elevated childhood non-HDL-C levels may help prevent premature CVD.

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