CHOLESTEROL AND CORONARY HEART-DISEASE - PREDICTING RISKS BY LEVELS AND RATIOS
CHOLESTEROL AND CORONARY HEART-DISEASE - PREDICTING RISKS BY LEVELS AND RATIOS
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DOI：
10.7326/0003-4819-121-9-199411010-00002
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发表时间：
1994-11-01
影响因子：
39.2
通讯作者：
GARLAND, G
中科院分区：
文献类型：
--
作者：
KINOSIAN, B;GLICK, H;GARLAND, G
目的：比较四种胆固醇指标预测男性和女性在8至10年内患冠心病的情况。设计：队列研究。患者：1898例接受安慰剂的男性（脂质研究诊所[LRC]冠状动脉一级预防试验[CPPT]的安慰剂组），1025名男性和1442名女性参加了1970-1971年心脏研究两年一次的检查，1911名男性和1767名女性没有冠心病，他们来自LRC人群患病率研究。总胆固醇、低密度脂蛋白（LDL）胆固醇、总胆固醇与高密度脂蛋白（HDL）胆固醇的比率以及LDL与HDL的比率。结果：总胆固醇/高密度脂蛋白比值的独立信息增加了总胆固醇和低密度脂蛋白胆固醇指标的风险识别能力（P < 0.02），但反之则不然。在女性中，总胆固醇/HDL比率的高风险阈值为5.6，在患病率和Fractionary研究中，分别比现行指南高出0%至15%的风险。在同一研究中的男性中，总胆固醇/HDL比率的风险阈值为6.4，确定了比单独LDL胆固醇水平高2%至14%的风险的69%至95%的群体。冠心病的8年似然比男性为0.32 ~ 3.11，女性为0.59 ~ 2.98，总胆固醇/高密度脂蛋白比值（从< 3到大于或等于9分组）。结论：与总胆固醇或低密度脂蛋白胆固醇水平相比，总胆固醇/高密度脂蛋白比值是冠心病风险的一个上级指标。如果风险分层是基于这个比率而不是主要基于LDL胆固醇水平，那么目前的实践指南可能会更有效。
Objective: Comparison of four measures of cholesterol for predicting men and women who will develop coronary heart disease within 8 to 10 years.Design: Cohort study.Patients: 1898 men who received placebo (the placebo group of the Lipid Research Clinics [LRC] Coronary Primary Prevention Trial [CPPT]), 1025 men and 1442 women who participated in the 1970-1971 Framingham Heart Study biennial examination, and 1911 men and 1767 women without coronary heart disease who were from the LRC Population Prevalence Study.Measurements: Total cholesterol, low-density lipoprotein (LDL) cholesterol, ratio of total cholesterol to high-density lipoprotein (HDL) cholesterol, and the ratio of LDL to HDL. Outcomes were coronary heart disease in the CPPT and Framingham studies and death from coronary heart disease in the Prevalence Study.Results: independent information in the total cholesterol/HDL ratio added risk-discriminating ability to total Cholesterol and LDL cholesterol measures (P < 0.02), but the reverse was not true. Among women, a high-risk threshold of 5.6 for the total cholesterol/HDL ratio identified a 0% to 15% larger group at 25% to 45% greater risk in the Prevalence and Framingham studies, respectively, than did current guidelines. Among men in the same studies, a risk threshold of 6.4 for the total cholesterol/HDL ratio identified a 69% to 95% larger group at 2% to 14% greater risk than did LDL cholesterol levels alone. Eight-year likelihood ratios for coronary heart disease ranged from 0.32 to 3.11 in men and from 0.59 to 2.98 in women for total cholesterol/HDL ratios (grouped from < 3 to greater than or equal to 9).Conclusions: The total cholesterol/HDL ratio is a superior measure of risk for coronary heart disease compared with either total cholesterol or LDL cholesterol levels. Current practice guidelines could be more efficient if risk stratification was based on this ratio rather than primarily on the LDL cholesterol level.