Serum total cholesterol and long-term coronary heart disease mortality in different cultures. Twenty-five-year follow-up of the seven countries study.
Serum total cholesterol and long-term coronary heart disease mortality in different cultures. Twenty-five-year follow-up of the seven countries study.
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DOI：
10.1001/jama.1995.03530020049031
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发表时间：
1995-07
期刊：
影响因子：
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通讯作者：
W. Verschuren;D. Jacobs;B. Bloemberg;D. Kromhout;A. Menotti;C. Aravanis;H. Blackburn;R. Buzina;A. Dontas;F. Fidanza
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文献类型：
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作者：
W. Verschuren;D. Jacobs;B. Bloemberg;D. Kromhout;A. Menotti;C. Aravanis;H. Blackburn;R. Buzina;A. Dontas;F. Fidanza
目的比较不同培养物血清总胆固醇与冠心病(CHD)远期死亡率的关系。设计总胆固醇是在基线(1958年至1964年)和5年和10年的随访时进行测量的，这些人来自7个国家：5个欧洲国家、美国和日本的16个队列中的12,467名年龄在40岁到59岁之间的男性。为了增加统计能力，根据前10年随访期间文化和胆固醇变化的相似性，形成了6个队列。主要观察指标用COX比例风险(生存)分析估计的相对危险度(RR)是胆固醇四分位数和每0.50-mmo1/L(20-mg/dL)胆固醇升高25年的冠心病死亡率。根据年龄、吸烟和收缩压进行了调整。结果6个队列的年龄标化冠心病死亡率为3%~20%。除日本的RR为1.1外，最高和最低四分位胆固醇的RRS在1.5到2.3之间。在胆固醇水平约为5.45mmo1/L(210mgdL)的情况下，日本和地中海南欧的冠心病死亡率从4%到5%不等，北欧的死亡率约为15%。然而，在除日本以外的所有文化中，由于特定胆固醇增加而导致的冠心病死亡率的相对增加是相似的。在线性近似下，总胆固醇每增加0.50 mmol/L(20 mg/dL)对应的冠心病死亡风险增加12%，调整回归稀释偏倚后死亡风险增加17%。结论：在不同的文化背景下，胆固醇与冠心病死亡率呈线性相关，且给定胆固醇升高时，冠心病死亡率的相对增加是相同的。然而，在给定的胆固醇水平下，CHD绝对死亡率的巨大差异表明，其他因素，如饮食，对于低CHD风险的培养来说，对于初级预防也是重要的。
OBJECTIVE To compare the relationship between serum total cholesterol and long-term mortality from coronary heart disease (CHD) in different cultures. DESIGN Total cholesterol was measured at baseline (1958 through 1964) and at 5- and 10-year follow-up in 12,467 men aged 40 through 59 years in 16 cohorts located in seven countries: five European countries, the United States, and Japan. To increase statistical power six cohorts were formed, based on similarities in culture and cholesterol changes during the first 10 years of follow-up. MAIN OUTCOME MEASURES Relative risks (RRs), estimated with Cox proportional hazards (survival) analysis, for 25-year CHD mortality for cholesterol quartiles and per 0.50-mmol/L (20-mg/dL) cholesterol increase. Adjustment was made for age, smoking, and systolic blood pressure. RESULTS The age-standardized CHD mortality rates in the six cohorts ranged from 3% to 20%. The RRs for the highest compared with the lowest cholesterol quartile ranged from 1.5 to 2.3, except for Japan's RR of 1.1. For a cholesterol level of around 5.45 mmol/L (210 mg/dL), CHD mortality rates varied from 4% to 5% in Japan and Mediterranean Southern Europe to about 15% in Northern Europe. However, the relative increase in CHD mortality due to a given cholesterol increase was similar in all cultures except Japan. Using a linear approximation, a 0.50-mmol/L (20-mg/dL) increase in total cholesterol corresponded to an increase in CHD mortality risk of 12%, which became an increase in mortality risk of 17% when adjusted for regression dilution bias. CONCLUSION Across cultures, cholesterol is linearly related to CHD mortality, and the relative increase in CHD mortality rates with a given cholesterol increase is the same. The large difference in absolute CHD mortality rates at a given cholesterol level, however, indicates that other factors, such as diet, that are typical for cultures with a low CHD risk are also important with respect to primary prevention.