10-YEAR MORTALITY FROM CARDIOVASCULAR-DISEASE IN RELATION TO CHOLESTEROL LEVEL AMONG MEN WITH AND WITHOUT PREEXISTING CARDIOVASCULAR-DISEASE
10-YEAR MORTALITY FROM CARDIOVASCULAR-DISEASE IN RELATION TO CHOLESTEROL LEVEL AMONG MEN WITH AND WITHOUT PREEXISTING CARDIOVASCULAR-DISEASE
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DOI：
10.1056/nejm199006143222403
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发表时间：
1990-06-14
影响因子：
158.5
通讯作者：
TYROLER, HA
中科院分区：
文献类型：
--
作者：
PEKKANEN, J;LINN, S;TYROLER, HA
为了确定总胆固醇、低密度脂蛋白（LDL）和高密度脂蛋白（HDL）胆固醇与冠心病和心血管疾病死亡率之间的关系，我们研究了2541名白色男性，基线年龄为40 - 69岁，平均随访10.1年。17%的人在基线时有一些心血管疾病的表现，而其他人没有。在基线时有心血管疾病的男性中，我们发现，经过多变量调整，那些血胆固醇水平“高”的人，（高于6.19 mmol/L）的人死于心血管疾病（包括冠心病）的风险高出3.45倍（95%的置信区间，1.63至7.33）比男性的“理想”的血液胆固醇水平（低于5.16毫摩尔每升）。相应的风险比为5.92（95%置信区间，2.59至13.51）的LDL胆固醇水平高于4.13 mmol/L相比，低于3.35 mmol/L，和6.02（95%置信区间，2.73至13.28）的HDL胆固醇水平低于0.90 mmol/L相比，高于1.16 mmol/L。所有三种血脂水平也是冠心病死亡的显著预测因素（P < 0.005）。总胆固醇和低密度脂蛋白胆固醇水平也是无心血管疾病男性心血管和冠心病死亡的重要预测因子，尽管死亡的绝对风险较低。因此，随着总胆固醇水平从“理想”增加到“高”，患有心血管疾病的男性10年心血管疾病死亡风险从3.8%增加到近19.6%，而基线时无心血管疾病的男性相应风险从1.7%增加到4.9%。我们的研究结果表明，总胆固醇、低密度脂蛋白和高密度脂蛋白胆固醇水平可预测40至69岁男性的后续死亡率，特别是那些先前存在心血管疾病的男性。
To determine the associations of total, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) cholesterol with mortality from coronary heart disease and cardiovascular disease, we studied 2541 white men who were 40 to 69 years old at base line and followed them for an average of 10.1 years. Seventeen percent had some manifestation of cardiovascular disease at base line, whereas the others did not. Among the men who had cardiovascular disease at base line, we found, after multivariate adjustment, that those with "high" blood cholesterol levels (above 6.19 mmol per liter) had a risk of death from cardiovascular disease, including coronary heart disease, that was 3.45 times higher (95 percent confidence interval, 1.63 to 7.33) than that for men with "desirable" blood cholesterol levels (below 5.16 mmol per liter). The corresponding hazard ratios were 5.92 (95 percent confidence interval, 2.59 to 13.51) for LDL cholesterol levels above 4.13 mmol per liter as compared with those below 3.35 mmol per liter, and 6.02 (95 percent confidence interval, 2.73 to 13.28) for HDL cholesterol levels below 0.90 mmol per liter as compared with those above 1.16 mmol per liter. All three lipid levels were also significant predictors of death from coronary heart disease alone (P < 0.005). Total cholesterol and LDL cholesterol levels were also significant predictors of death from cardiovascular and coronary heart disease in men without preexisting cardiovascular disease, although at a lower level of absolute risk of death. Thus, the 10-year risk of death from cardiovascular disease for a man with preexisting cardiovascular disease increased from 3.8 percent to almost 19.6 percent with increasing levels of total cholesterol from "desirable" to "high," whereas the corresponding risk for a man who was free of cardiovascular disease at base line increased from 1.7 percent to 4.9 percent. Our findings suggest that total, LDL, and HDL cholesterol levels predict subsequent mortality in men 40 to 69 years of age, especially those with preexisting cardiovascular disease.