Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55000 vascular deaths
Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55000 vascular deaths
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DOI：
10.1016/s0140-6736(07)61778-4
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发表时间：
2007-12-01
期刊：
影响因子：
168.9
通讯作者：
Collins, Rory
中科院分区：
文献类型：
--
作者：
Lewington, Sarah;Whitlock, Gary;Collins, Rory
背景年龄、性别和血压可以改变总胆固醇（及其主要的两个组分，HDL和LDL胆固醇）与血管性死亡率的关系。这一荟萃分析结合血管死亡率的前瞻性研究，记录血压和总胆固醇在基线，以确定这两个危险factors.Methods信息的联合相关性，从61个前瞻性观察性研究，主要是在西欧或北美，包括近90万成年人没有以前的疾病和基线测量总胆固醇和血压。在近1200万人年的风险之间的40和89岁，有超过55000血管死亡（34000缺血性心脏病[IHD]，12000中风，10000其他）。150000名参与者的HDL胆固醇信息可用，其中有5000例血管性死亡（3000例IHD，1000例中风，1000例其他）。报告的协会与通常的胆固醇水平（即，校正回归稀释偏倚）。44 [95% CI 0.42-0.48]），在大多数发达国家胆固醇的主要范围内，40-49岁、50-69岁和70-89岁时，两种性别的IHD死亡率分别降低三分之一（0.66 [0.65-0.68]）和六分之一（0.83 [0.81-0.85]），无明显阈值。风险降低比例随着血压的升高而降低，因为胆固醇和血压的绝对效应近似于相加。在涉及HDL胆固醇的各种简单指标中，总/HDL胆固醇比率是IHD死亡率的最强预测因子（比非HDL胆固醇多40%的信息量，是总胆固醇的两倍多）。在中年早期（40-59岁），总胆固醇与缺血性和总卒中死亡率呈弱正相关，但这一发现可以在很大程度上或全部由胆固醇与血压的相关性解释。此外，仅在中年和血压低于平均水平的人群中观察到正相关;在老年（70-89岁），特别是收缩压超过145 mm Hg的人群中，总胆固醇与出血和总卒中死亡率呈负相关。其他血管死亡率的结果是中间的IHD和stroke.Interpretation总胆固醇与IHD死亡率在中年和老年，并在所有的血压水平呈正相关。胆固醇与中风死亡率之间没有独立的正相关关系，特别是在老年或高血压患者中，这一点尚无法解释，需要进一步研究。然而，随机试验的结论性证据表明，他汀类药物不仅大大降低了冠状动脉事件发生率，而且降低了各种年龄和血压患者的总卒中发生率。
Background Age, sex, and blood pressure could modify the associations of total cholesterol (and its main two fractions, HDL and LDL cholesterol) with vascular mortality. This meta-analysis combined prospective studies of vascular mortality that recorded both blood pressure and total cholesterol at baseline, to determine the joint relevance of these two risk factors.Methods Information was obtained from 61 prospective observational studies, mostly in western Europe or North America, consisting of almost 900000 adults without previous disease and with baseline measurements of total cholesterol and blood pressure. During nearly 12 million person years at risk between the ages of 40 and 89 years, there were more than 55000 vascular deaths (34000 ischaemic heart disease [IHD], 12000 stroke, 10000 other). Information about HDL cholesterol was available for 150000 participants, among whom there were 5000 vascular deaths (3000 IHD, 1000 stroke, 1000 other). Reported associations are with usual cholesterol levels (ie, corrected for the regression dilution bias).Findings 1 mmol/L lower total cholesterol was associated with about a half (hazard ratio 0 . 44 [95% CI 0.42-0.48]), a third (0.66 [0.65-0.68]), and a sixth (0.83 [0.81-0.85]) lower IHD mortality in both sexes at ages 40-49, 50-69, and 70-89 years, respectively, throughout the main range of cholesterol in most developed countries, with no apparent threshold. The proportional risk reduction decreased with increasing blood pressure, since the absolute effects of cholesterol and blood pressure were approximately additive. Of various simple indices involving HDL cholesterol, the ratio total/HDL cholesterol was the strongest predictor of IHD mortality (40% more informative than non-HDL cholesterol and more than twice as informative as total cholesterol). Total cholesterol was weakly positively related to ischaemic and total stroke mortality in early middle age (40-59 years), but this finding could be largely or wholly accounted for by the association of cholesterol with blood pressure. Moreover, a positive relation was seen only in middle age and only in those with below-average blood pressure; at older ages (70-89 years) and, particularly, for those with systolic blood pressure over about 145 mm Hg, total cholesterol was negatively related to haemorrhagic and total stroke mortality. The results for other vascular mortality were intermediate between those for IHD and stroke.Interpretation Total cholesterol was positively associated with IHD mortality in both middle and old age and at all blood pressure levels. The absence of an independent positive association of cholesterol with stroke mortality, especially at older ages or higher blood pressures, is unexplained, and invites further research. Nevertheless, there is conclusive evidence from randomised trials that statins substantially reduce not only coronary event rates but also total stroke rates in patients with a wide range of ages and blood pressures.