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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 簡國龍(Kuo-Liong Chien) | |
dc.contributor.author | Hsin-Yin Hsu | en |
dc.contributor.author | 許馨尹 | zh_TW |
dc.date.accessioned | 2021-06-15T12:55:44Z | - |
dc.date.available | 2021-09-01 | |
dc.date.copyright | 2020-09-02 | |
dc.date.issued | 2020 | |
dc.date.submitted | 2020-08-11 | |
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/50742 | - |
dc.description.abstract | 背景 致動脈粥狀硬化的血脂値上升已確定為心血管事件風險的危險因子。但是關於血脂改變對心血管和全死因風險的作用的證據目前尚無定論。 方法 根據台灣三高主題資料庫進行一全國代表性的社區前瞻性世代研究(4072成年人,平均44.8歲,53.5%女性)。在2002年和2007年進行了兩次次血脂測量。將血脂基準值和其變化量分為四類:包括低和高風險血脂基準值合併穩定或減少的血脂變化和增加的血脂變化。 結果 在中位數13.3年的追蹤中確定了新發的225心血管事件(n=225)和全因死亡(n=345)。與下降和低非高密度膽固醇值的參與者相比,增加非高密度膽固醇值的參與者有較高的心血管疾病的風險(調整後的危險比[HR],1.32,95%信賴區間[CI],0.75-2.32,於低非高密度膽固醇值;HR,1.64,95%CI,0.97-2.77,於高非高密度膽固醇值)。與下降和低非高密度膽固醇值的人相比,增加非高密度膽固醇值的參與者的全因死亡風險為較低(低非高密度膽固醇值,HR,0.59,95%CI,0.37-0.94;低非高密度膽固醇值,HR,0.57,95%CI,0.36-0.90)。在其他脂質變化中觀察到了類似的心血管事件和全死因風險的模式。 結論 血脂基準值和其變化量與心血管疾病的風險顯著相關,而與全死因風險呈負相關。尚須進一步研究來釐清血脂基準值和其變化量與心血管疾病和全死因的風險的生物學機制。 | zh_TW |
dc.description.abstract | Background High baseline atherogenic lipid level has been an established risk factor for the risk of cardiovascular events. However, evidence about the role of lipid change for cardiovascular and death risks was inconclusive. Methods A cohort study based on the Taiwanese Survey on Hypertension, Hyperglycemia, and Hyperlipidemia (n, 4072, mean 44.8 years, 53.5% women) was conducted with repeated lipid measurements during 2002 and 2007. Combined baseline and change of lipid levels were classified into four groups, including stable or decreasing lipid change and increasing lipid change with low and high-risk baseline lipid levels. Results New developing cardiovascular events (n, 225), and all-cause deaths (n, 345) were ascertained during a median of 13.3 years’ follow-up. Compared with those in decreasing and lower nonHDL cholesterol, participants in increasing nonHDL cholesterol level were likely to have a cardiovascular risk (adjusted hazard ratio [HR], 1.32, 95% confidence interval [CI], 0.75-2.32, for low NonHDL; HR, 1.64, 95% CI, 0.97-2.77, for high HDL level). Compared with those in decreasing and lower NonHDL cholesterol, participants in increasing NonHDL cholesterol level were likely to have a lower risk for all-cause death (adjusted HR, 0.59, 95%CI, 0.37-0.94, for low NonHDL; HR, 0.57, 95% CI, 0.36-0.90, for high NonHDL). Similar patterns for cardiovascular events and all-cause death were observed across other lipid change. Conclusion Baseline and the change in lipid profiles were significantly associated with the risk of cardiovascular diseases and inversely associated with the all-cause death. Further studies about biological mechanism for the role of baseline and change in lipid levels are warranted. | en |
dc.description.provenance | Made available in DSpace on 2021-06-15T12:55:44Z (GMT). No. of bitstreams: 1 U0001-1008202023072900.pdf: 3050289 bytes, checksum: e26ae3f9d411fa294fb8d2931e6abccd (MD5) Previous issue date: 2020 | en |
dc.description.tableofcontents | 致謝................................................................................................................................ ii 摘要.............................................................................................................................. iii Abstract .......................................................................................................................... v List of Tables ................................................................................................................. ix List of Figures ............................................................................................................... xi Chapter I Introduction .................................................................................................... 1 1.1 Hyperlipidemia and Cardiovascular diseases Cardiovascular disease ............. 1 1.1.1 Hyperlipidemia and coronary heart diseases ........................................ 2 1.1.2 Hyperlipidemia and ischemic strokes ................................................... 3 1.1.3 The change of lipid level and cardiovascular risks ............................... 4 1.2 Hyperlipidemia and All-cause death ................................................................ 4 1.3 Potential effect modifiers ................................................................................. 5 1.4 Knowledge gaps ............................................................................................... 8 Chapter II Objectives ................................................................................................... 10 Chapter III Methods ..................................................................................................... 11 3.1 Study design and participants ........................................................................ 11 3.2 Data source..................................................................................................... 11 3.2.1 Taiwan’s Hypertensive, Hyperglycemia, Hyperlipidemia Survey 2002...................................................................................................................... 12 3.2.2 Taiwan’s Hypertensive, Hyperglycemia, Hyperlipidemia Survey 2007...................................................................................................................... 13 3.2.3 National Health Interview Survey 2001 ............................................. 13 3.2.4 Taiwan’s National Health Insurance Research Database .................... 14 3.3 Laboratory measurements .............................................................................. 14 3.4 Definition of exposures .................................................................................. 15 3.5 Definition of outcomes .................................................................................. 16 3.6 Definitions of covariates ................................................................................ 17 3.7 Statistical analyses ......................................................................................... 18 3.7.1 Descriptive part ................................................................................... 18 3.7.2 Analytical part ..................................................................................... 19 3.7.3 Sample size calculation ....................................................................... 20 Chapter IV Results ....................................................................................................... 22 4.1 Descriptive part .............................................................................................. 22 4.1.1 Baseline characteristics of the study participants ............................... 22 4.1.2 Pearson correlation coefficients between various lipid profiles ......... 23 4.1.3 Distributions in different categories of Combined lipid change ......... 23 4.1.4 Incident Events.................................................................................... 24 4.1.5 The Kaplan-Meier survival curves of the cardiovascular diseases according to lipid quartiles and combined lipid change .............................. 25 4.1.6 The Kaplan-Meier survival curves of the all-cause deaths according to lipid quartiles and combined lipid change ................................................... 25 4.2 Analytical analyses......................................................................................... 26 4.2.1 Baseline lipid profiles ......................................................................... 26 4.2.2 Joint analyses of combined lipid change ............................................ 28 4.2.3 Subgroup analyses .............................................................................. 30 4.2.4 Sensitivity analyses ............................................................................. 32 Chapter V Discussion .................................................................................................. 33 5.1 Main findings ................................................................................................. 33 5.2 Comparison with previous studies ................................................................. 33 5.2.1 Cardiovascular outcomes .................................................................... 33 5.2.2 All-cause death.................................................................................... 35 5.3 Biological mechanisms .................................................................................. 36 5.3.1 Cardiovascular outcomes .................................................................... 37 5.3.2 All-cause death.................................................................................... 38 5.4 Clinical implications ...................................................................................... 38 5.5 Strengths and Limitations .............................................................................. 39 5.5.1 Strengths ............................................................................................. 39 5.5.2 Limitations .......................................................................................... 40 5.6 Conclusion ..................................................................................................... 41 Reference ................................................................................................................... 104 Appendixes ................................................................................................................ 110 | |
dc.language.iso | zh-TW | |
dc.title | 血脂基準值合併血脂變化量對心血管疾病和全死因風險的相關性研究:全國代表性世代追蹤研究 | zh_TW |
dc.title | Association of Baseline as well as Change in Lipid Levels with the Risk of Cardiovascular Diseases and All-Cause Deaths: A Representative Cohort Study in Taiwan | en |
dc.type | Thesis | |
dc.date.schoolyear | 108-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 杜裕康(Yu-Kang Tu),黃麗卿(Lee-Ching Hwang),白其卉(Chi-Hui Bai),蘇大成(Ta-Chen Su) | |
dc.subject.keyword | 血脂變化,心血管疾病,冠心病,缺血性中風,全死因, | zh_TW |
dc.subject.keyword | lipid change,cardiovascular disease,coronary heart disease,ischemic stroke,all cause death, | en |
dc.relation.page | 128 | |
dc.identifier.doi | 10.6342/NTU202002880 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2020-08-12 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 流行病學與預防醫學研究所 | zh_TW |
顯示於系所單位: | 流行病學與預防醫學研究所 |
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