Serum cholesterol and mortality rates in a native American population with low cholesterol concentrations - A U-shaped association
Serum cholesterol and mortality rates in a native American population with low cholesterol concentrations - A U-shaped association
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DOI：
10.1161/01.cir.96.5.1408
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发表时间：
1997-09-02
期刊：
影响因子：
37.8
通讯作者：
Knowler, WC
中科院分区：
文献类型：
--
作者：
FagotCampagna, A;Hanson, RL;Knowler, WC
低血清胆固醇浓度与癌症、创伤和传染病的高死亡率相关，但这些关联的意义仍存在争议。本报告评估低胆固醇是否可能是所有原因或特定原因导致死亡的一个原因。方法与结果在4553名年龄大于或等于20梨的皮马印第安人中，血清胆固醇低（中位数4.50 mmol/L），在平均12.8年的随访期间发生1077例死亡。创伤是最常见的原因。每2年测量一次的血清胆固醇与年龄和性别标准化死亡率之间呈u型关系。胆固醇与心血管疾病和糖尿病（包括肾病）的死亡率呈正相关，与癌症和酒精相关疾病的死亡率呈负相关。传染病死亡率呈u型关系，而胆固醇与创伤死亡率无关。从一次检查到下一次检查的胆固醇变化与糖尿病死亡率呈正相关。在调整了潜在混杂因素的比例风险模型中，基线胆固醇与死亡率之间的关系在所有原因和糖尿病中呈u型，在心血管疾病中呈正相关。其他关系不显著。在随访大于或等于5年的3358名受试者中，只有心血管疾病死亡率的相关性显著且呈正相关。结论尽管皮马印第安人暴露风险高，但如果低胆固醇水平是一个因果因素，低血清胆固醇与高死亡率之间的关系可能是由于降低胆固醇的疾病而不是低胆固醇引起的疾病。
Background Low serum cholesterol concentrations are associated with high death rates from cancer, trauma, and infectious diseases, but the meaning of these associations remains controversial. The present report evaluates whether low cholesterol is likely to be a causal factor for mortality from all causes or from specific causes.Methods and Results Among 4553 Pima Indians greater than or equal to 20 pears old, a population with low serum cholesterol (median, 4.50 mmol/L), 1077 deaths occurred during a mean follow-up of 12.8 years. Trauma was the most common cause. The relationship between serum cholesterol measured at 2-year intervals and age-and sex-standardized mortality rates was U-shaped. Cholesterol was related positively to mortality from cardiovascular diseases and diabetes (including nephropathy) and negatively to mortality from cancer and alcohol-related diseases. The relationship was U-shaped for mortality from infectious diseases, and cholesterol was not related to mortality from trauma. Change in cholesterol from one examination to the next was positively related to mortality from diabetes. In proportional-hazards models adjusted for potential confounders, the relationship between baseline cholesterol and mortality was U-shaped for all causes and diabetes and positive for cardiovascular diseases. Other relationships were nonsignificant. Among 3358 subjects followed greater than or equal to 5 years, the relationship was significant and positive only for mortality from cardiovascular diseases.Conclusions Despite a high exposure risk for Pima Indians, If low cholesterol level is a causal factor, the relationships between low serum cholesterol and high mortality rates probably result from diseases lowering cholesterol rather than from a low cholesterol causing the diseases.