Cholesterol fractions and apolipoproteins as risk factors for heart disease mortality in older men
Cholesterol fractions and apolipoproteins as risk factors for heart disease mortality in older men
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DOI：
10.1001/archinte.167.13.1373
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发表时间：
2007-07-09
影响因子：
--
通讯作者：
Collins, Rory
中科院分区：
文献类型：
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作者：
Clarke, Robert;Emberson, Jonathan R.;Collins, Rory
背景资料：血脂水平作为老年人缺血性心脏病（IHD）危险因素的相关性尚不确定，因此，降胆固醇治疗并不是老年人的常规处方。方法：我们评估了老年男性IHD死亡率与血浆总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、载脂蛋白B和载脂蛋白A（1）水平的相关性。对5344名男性（平均年龄76.9岁）进行了7年随访，评估了缺血性心脏病，其中74.3%没有心血管疾病（CVD）或使用他汀类药物，25.6%有心血管疾病或使用他汀类药物。447例IHD死亡的危险比（HR）估计为2-SD差异在通常的血浆lipidlevel.Results：缺血性心脏病的死亡率是不显着相关的总胆固醇水平在所有的男人（HR，1.05），但一个显着的正相关，在男性无CVD和轻微的非显着的负相关，在男性与CVD观察（HR，1.47比0.84）。低密度脂蛋白胆固醇水平（HR，1.50 vs 0.98）和载脂蛋白B水平（HR，1.68 vs 0.93）的模式相似。缺血性心脏病的风险与高密度脂蛋白胆固醇水平和载脂蛋白A（1）水平呈负相关，无论是否患有心血管疾病。缺血性心脏病风险与总高密度脂蛋白胆固醇水平（HR，1.57）和载脂蛋白B-载脂蛋白A（1）水平（HR，1.54）密切相关，并且在所有年龄段都保持密切相关。无论年龄大小，他汀类药物使用可达到的血脂水平差异与IHD风险降低约三分之一相关。
Background: The relevance of blood lipid levels as risk factors for ischemic heart disease (IHD) in older people is uncertain; hence, cholesterol-lowering therapy is not routinely prescribed in older populations.Methods: We assessed IHD mortality associations with plasma levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, apolipoprotein B, and apolipoprotein A(1) measured in older men. Ischemic heart disease was assessed in a 7-year follow-up of a cohort of 5344 men (mean age, 76.9 years), including 74.3% without cardiovascular disease (CVD) or statin use and 25.6% with CVD or statin use. Hazard ratios (HRs) for 447 deaths from IHD were estimated for a 2-SD difference in usual plasma lipid levels.Results: Ischemic heart disease mortality was not significantly associated with total cholesterol levels in all men (HR, 1.05), but a significant positive association in men without CVD and a slight nonsignificant inverse association in men with CVD were observed (HR, 1.47 vs 0.84). The patterns were similar for low-density lipoprotein cholesterol levels (HR, 1.50 vs 0.98) and for apolipoprotein B levels (HR, 1.68 vs 0.93). Ischemic heart disease risks were inversely associated with high-density lipoprotein cholesterol levels and with apolipoprotein A(1) levels in men with and without CVD. Ischemic heart disease risks were strongly associated with total-high-density lipoprotein cholesterol levels (HR, 1.57) and apolipoprotein B-apolipoprotien A(1) levels (HR, 1.54), and remained strongly related at all ages.Conclusions: Blood lipid levels other than total cholesterol levels were associated with IHD in older men. Differences in lipid levels that are achievable by statin use were associated with about a one-third lower risk of IHD, irrespective of age.