TOTAL SERUM-CHOLESTEROL LEVELS AND MORTALITY RISK AS A FUNCTION OF AGE - A REPORT BASED ON THE FRAMINGHAM DATA
TOTAL SERUM-CHOLESTEROL LEVELS AND MORTALITY RISK AS A FUNCTION OF AGE - A REPORT BASED ON THE FRAMINGHAM DATA
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DOI：
10.1001/archinte.153.9.1065
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发表时间：
1993-05-10
影响因子：
--
通讯作者：
OMENN, GS
中科院分区：
文献类型：
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作者：
KRONMAL, RA;CAIN, KC;OMENN, GS
目的：为了评估血清胆固醇水平和全因，冠心病（CHD），非CHD死亡率作为一个函数的年龄。方法：数据来源是两年一次的检查数据，从1948年至1980年的5209名男性和女性参加了心脏研究。通过考克斯比例风险回归模型对所有入组且在每个规定年龄存活的受试者在40、50、60、70和80岁后的生存率进行了特定风险分析。补充模型进行了研究，使用高密度脂蛋白胆固醇，低密度脂蛋白胆固醇，或总胆固醇水平作为预测生存的检查后，在脂蛋白亚组分确定（1968年至1973年）。结果：总胆固醇水平与全因死亡率呈正相关40岁时胆固醇水平升高（即胆固醇水平升高与死亡率升高相关），80岁时为阴性，50至70岁时可忽略不计。在40岁、50岁和60岁时，与CHD死亡率的关系显著正相关，但随着年龄的增长而减弱，直到70岁时为正相关，但不显著，80岁时为负相关，但不显著。低密度脂蛋白胆固醇和高密度脂蛋白胆固醇与死亡率的关系有助于解释这些发现，50岁及以上的非冠心病死亡率与胆固醇水平呈显著负相关。最大年龄组的全因和CHD死亡率的阴性结果似乎是由于与低密度脂蛋白胆固醇水平的负相关，而不是高密度脂蛋白胆固醇水平的保护作用。类似的结果从几个修改后的分析低胆固醇水平，由于严重的疾病不太可能解释我们的results.Conclusions：医生应该谨慎开始降胆固醇治疗的男性和女性在65至70岁以上。只有在老年人中进行随机临床试验，才能解决关于降脂干预措施降低老年人死亡率和发病率的有效性和成本效益的争论。
Objectives: To evaluate the relationship between serum cholesterol level and all-cause, coronary heart disease (CHD), and non-CHD mortality as a function of age.Methods: The data source was the biennial examination data from 1948 through 1980 for the 5209 men and women enrolled in the Framingham Heart Study. Age-specific analyses by the Cox proportional hazards regression model were performed of survival subsequent to ages 40, 50, 60, 70, and 80 years for all subjects enrolled and alive at each of the stated ages. Complementary models were studied that used high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, or total cholesterol level as predictors of survival subsequent to the examination at which lipoprotein subfractions were determined (1968 through 1973).Results: The relationship between total cholesterol level and all-cause mortality was positive (ie, higher cholesterol level associated with higher mortality) at age 40 years, negative at age 80 years, and negligible at ages 50 to 70 years. The relationship with CHD mortality was significantly positive at ages 40, 50, and 60 years but attenuated with age until the relationship was positive, but not significant, at age 70 years and negative, but not significant, at age 80 years. Results for the relationship between low-density lipoprotein cholesterol and high-density lipoprotein cholesterol and mortality help explain these findings.Non-CHD mortality was significantly negatively related to cholesterol level for ages 50 years and above. The negative results in the oldest age group for all-cause and CHD mortality appeared to be due to a negative relationship with low-density lipoprotein cholesterol levels rather than the protective effect of high high-density lipoprotein cholesterol levels. Similar results from several modified analyses make low cholesterol level due to severe illness an unlikely explanation for our results.Conclusions: Physicians should be cautious about initiating cholesterol-lowering treatment in men and women above 65 to 70 years of age. Only randomized clinical trials in older people can settle the debate over the efficacy and cost-effectiveness of lipid-lowering interventions for reducing mortality and morbidity in this population.