LOW CHOLESTEROL AND DISEASE IN A LARGE AGING COHORT

一项针对137,223名成年人的拟议流行病学研究 在Kaiser Permanente Medical接受多阶段健康检查(MHC) 旧金山和加利福尼亚州奥克兰的CARE计划将审查 低胆固醇血症与健康结局的关系。它是 预计将确认TC与动脉粥样硬化原因之间的关系 死亡(阳性)以及TC和非动脉粥样硬化性死亡原因之间的关系 (相反)最近由19项队列研究组成的联盟报告。会的 是第一个研究TC与许多对应关系的人 致病原因。有几种疾病特别令人感兴趣，因为 观察到与TC呈负相关：出血性中风、肺、 血液癌、淋巴癌和肝癌；创伤性死亡，包括 自杀；慢性阻塞性肺疾病和其他呼吸道疾病 疾病；肝炎、肝硬变等消化系统疾病； 脱髓鞘疾病；以及感染。这些自我报告是预先存在的 MHC检查中的疾病将被排除在特定疾病之外 分析，并且有大量的自我报告酒精摄入量信息 调查。因为数据库是如此之大，高度特异的疾病 假说也可以研究。使用寿命表方法，差分 将按TC类别检查危险的时间进程，以查看是否 随着时间的推移，危险会减少。这项研究将询问是否有 TC相关性较弱的疾病，但对 在生命的末期发挥更大的作用。因为很多人重复 多阶段考试，它将揭示TC的时间进程 疾病，以及哪些疾病会导致早期TC降低 自然历史。这项研究将研究性别、年龄和吸烟 吸烟相互作用，并将有助于描述吸烟的性质 低TC与非动脉粥样硬化性疾病的关系：程度 这是由于过度饮酒等因素造成的 摄入量和既往发病率，以及看似合理的程度 生物机制可能正在发挥作用。拟议的研究旨在 澄清观察到的关联特别相关，因为当前 针对降低TC的饮食调整的公共卫生政策 在整个人口中的水平。我们需要知道这可能会产生什么影响 从一开始就对TC低的人进行计划。

The proposed epidemiologic study of a cohort of 137,223 adults who underwent multiphasic health checkups (MHC) at Kaiser Permanente Medical Care Program in San Francisco and Oakland, California, will examine the relationship of low blood total cholesterol (TC) to health outcomes. It is expected to confirm relations between TC and atherosclerotic causes of death (positive) and between TC and nonatherosclerotic causes of death (inverse) recently reported by a consortium of 19 cohort studies. It will be the first to study the relations of TC to many of the corresponding causes of morbidity. Several diseases are of specific interest because of observed inverse associations with TC:hemorrhagic stroke; lung, hematopoietic, lymphatic and liver cancers; traumatic death, including suicide; chronic obstructive pulmonary disease and other respiratory diseases; hepatitis, liver cirrhosis and other digestive diseases; demyelinating diseases; and infections. Those self-reporting pre-existing diseases at an MHC examination will be excluded from disease-specific analysis, and there is extensive self-report alcohol intake information for investigation. Because the database is so large, highly specific diseases and hypotheses can be studied. Using life table methods, the differential time course of hazard by TC category will be examined, to see whether hazard lessens as time passes. This study will ask whether there are diseases for which TC associations are weak for morbidity, but play a stronger role in terminal phases of life. Since many people have repeat multiphasic exams, it will shed light on the time course of TC during disease, and on which diseases result in a lowered TC early in their natural history. This research will study gender, age and cigarette smoking interactions, and will help to delineate the nature of the relationships of low TC with nonatherosclerotic diseases: the extent to which they are due to confounding by such factors as excessive alcohol intake and pre-existing morbidity, and the extent to which plausible biological mechanisms may be operating. The proposed study aiming to clarify observed associations is particularly relevant because of current public health policy directed at dietary modifications that reduce TC levels in the entire population. We need to know the likely effect of this program in those with low TC at the outset.