Cholesterol and all-cause mortality in elderly people from the Honolulu Heart Program: a cohort study
Cholesterol and all-cause mortality in elderly people from the Honolulu Heart Program: a cohort study
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DOI：
10.1016/s0140-6736(01)05553-2
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发表时间：
2001-08-04
期刊：
影响因子：
168.9
通讯作者：
Curb, JD
中科院分区：
文献类型：
--
作者：
Schatz, IJ;Masaki, K;Curb, JD
背景人们普遍认为，胆固醇浓度应保持在较低水平，以降低心血管疾病的风险。然而，关于血清胆固醇与老年人全因死亡率之间关系的研究显示了相反的结果。为了调查这些差异，我们做了一个纵向评估的变化，在脂质和血清胆固醇浓度超过20年，并将其与mortality.Methods的脂质和血清胆固醇浓度进行了测定，在3572日本/美国男性（年龄71-93岁）的一部分，檀香山心脏计划。我们比较了这些浓度的变化超过20年的所有情况下死亡率使用三种不同的考克斯比例风险models.Findings胆固醇平均值随年龄的增加显着下降。胆固醇浓度的第一至第四四个四分位数的校正死亡率分别为68.3、48.9、41.1和43.3。第二、第三和第四四个四分位数的死亡相对风险分别为0.72（95% CI 0.60-0.87）、0.60（0.49-0.74）和0.65（0.53-0.80），以四分位数1为参考。考克斯比例风险模型评估了第三次和第四次检查之间胆固醇浓度的变化。只有在两次检查中胆固醇浓度均较低的组与死亡率有显著相关性（风险比1.64，95%CI 1.13-2.36）。解释我们无法解释我们的结果。这些数据对将胆固醇降至极低浓度的科学依据提出了质疑（
Background A generally held belief is that cholesterol concentrations should be kept low to lessen the risk of cardiovascular disease. However, studies of the relation between serum cholesterol and all-cause mortality in elderly people have shown contrasting results. To investigate these discrepancies, we did a longitudinal assessment of changes in both lipid and serum cholesterol concentrations over 20 years, and compared them with mortality.Methods Lipid and serum cholesterol concentrations were measured in 3572 Japanese/American men (aged 71-93 years) as part of the Honolulu Heart Program. We compared changes in these concentrations over 20 years with all-case mortality using three different Cox proportional hazards models.Findings Mean cholesterol fell significantly with increasing age. Age-adjusted mortality rates were 68.3, 48.9, 41.1, and 43.3 for the first to fourth quartiles of cholesterol concentrations, respectively. Relative risks for mortality were 0.72 (95% CI 0.60-0.87), 0.60 (0.49-0.74), and 0.65 (0.53-0.80), in the second, third, and fourth quartiles, respectively, with quartile 1 as reference. A Cox proportional hazard model assessed changes in cholesterol concentrations between examinations three and four. Only the group with low cholesterol concentration at both examinations had a significant association with mortality (risk ratio 1.64, 95% CI 1.13-2.36).Interpretation We have been unable to explain our results. These data cast doubt on the scientific justification for lowering cholesterol to very low concentrations (