IS RELATIONSHIP BETWEEN SERUM-CHOLESTEROL AND RISK OF PREMATURE DEATH FROM CORONARY HEART-DISEASE CONTINUOUS AND GRADED - FINDINGS IN 356 222 PRIMARY SCREENEES OF THE MULTIPLE RISK FACTOR INTERVENTION TRIAL (MRFIT)
IS RELATIONSHIP BETWEEN SERUM-CHOLESTEROL AND RISK OF PREMATURE DEATH FROM CORONARY HEART-DISEASE CONTINUOUS AND GRADED - FINDINGS IN 356 222 PRIMARY SCREENEES OF THE MULTIPLE RISK FACTOR INTERVENTION TRIAL (MRFIT)
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DOI：
10.1001/jama.256.20.2823
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发表时间：
1986-11-28
影响因子：
120.7
通讯作者：
NEATON, JD
中科院分区：
文献类型：
--
作者：
STAMLER, J;WENTWORTH, D;NEATON, JD
多危险因素干预试验（MRFIT）在招募过程中筛选了356 222名年龄在35至57岁之间、无心肌梗死住院史的男性，构成了标准化血清胆固醇测量和长期死亡率随访的最大队列。对于每个5岁年龄组，血清胆固醇与冠心病（CHD）死亡率之间的关系是连续的、分级的和强烈的。在整个35 - 57岁的人群中，年龄调整后的胆固醇五分位数2 - 5（182 - 202、203 - 220、221 - 244和.gtoreq）的冠心病死亡风险。245毫克/分升[4.71至5.22,5.25至5.69,5.72至6.31，和。gtoreq。6.34 mmol/L])，相对最低五分位数分别为1.29、1.73、2.21和3.42。在所有冠心病死亡中，估计46%是由于血清胆固醇水平为180 mg/dL或更高（.gtoreq）导致的过量死亡。4.65 mmol/L)，几乎一半的超额死亡发生在血清胆固醇五分位数2至4之间。在非高血压不吸烟者、非高血压吸烟者、高血压不吸烟者和高血压吸烟者中，血清胆固醇与6年年龄调整后冠心病死亡率之间存在持续、分级、强烈的关系。这些高精度的数据表明，血清胆固醇与冠心病之间的关系不是一个阈值关系，风险增加仅限于两个最高的五分之一，而是一个持续分级的关系，它有力地影响了绝大多数美国中年男性的风险。
The 356 222 men aged 35 to 57 years, who were free of a history of hospitalization for myocardial infarction, screened by the Multiple Risk Factor Intervention Trial (MRFIT) in its recruitment effort, constitute the largest cohort with standardized serum cholesterol measurements and long-term mortality follow-up. For each five-year age group, the relationship between serum cholesterol and coronary heart disease (CHD) death rate was continuous, graded, and strong. For the entire group aged 35 to 57 years at entry, the age-adjusted risks of CHD death in cholesterol quintiles 2 through 5 (182 to 202, 203 to 220, 221 to 244, and .gtoreq. 245 mg/dL [4.71 to 5.22, 5.25 to 5.69, 5.72 to 6.31, and .gtoreq. 6.34 mmol/L]) relative to the lowest quintile were 1.29, 1.73, 2.21, and 3.42. Of all CHD deaths, 46% were estimated to be excess deaths attributable to serum cholesterol levels 180 mg/dL or greater (.gtoreq. 4.65 mmol/L), with almost half the excess deaths in serum cholesterol quintiles 2 through 4. The pattern of a continuous, graded, strong relationship between serum cholesterol and six-year age-adjusted CHD death rate prevailed for nonhypertensive nonsmokers, nonhypertensive smokers, hypertensive nonsmokers, and hypertensive smokers. These data of high precision show that the relationship between serum cholesterol and CHD is not a threshold one, with increased risk confined to the two highest quintiles, but rather is a continuously graded one that powerfully affects risk for the great majority of middle-aged American men.