LOW CHOLESTEROL AND DISEASE IN A LARGE AGING COHORT

一项针对137,223名成年人的流行病学研究， 在Kaiser Permanente Medical接受多相健康检查（MHC） 在旧金山弗朗西斯科和奥克兰，加州，护理计划，将审查 低血液总胆固醇（TC）与健康结果的关系。 是 预计将证实TC和动脉粥样硬化原因之间的关系， 死亡（阳性）以及TC和非动脉粥样硬化死亡原因之间的差异 （反向）最近由19项队列研究组成的联盟报告。 它将 是第一个研究TC与许多相应的 发病原因。 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， 造血、淋巴和肝癌;创伤性死亡，包括 自杀;慢性阻塞性肺病和其他呼吸系统疾病 肝炎、肝硬化等消化系统疾病; 脱髓鞘疾病;和感染。 那些自我报告预先存在的 MHC检查中的疾病将被排除在疾病特异性 分析，并有广泛的自我报告酒精摄入量的信息， 调查 因为数据库是如此庞大， 可以研究假设。 使用寿命表方法， 将按TC类别检查危害的时间进程，以确定是否 危险随着时间的推移而减少。 本研究将探讨是否存在 TC相关疾病的发病率较低，但在 在生命的最后阶段发挥更大的作用。 因为很多人都重复 多相检查，它将揭示TC的时间过程中， 疾病，以及哪些疾病导致TC降低， 自然史 这项研究将研究性别，年龄和吸烟 吸烟的相互作用，并将有助于描绘的性质， 低TC与非动脉粥样硬化性疾病的关系： 这是由于诸如过量饮酒等因素的混淆 摄入量和先前存在的发病率，以及合理的 生物学机制可能正在运作。 拟议的研究旨在 澄清观察到的关联是特别相关的，因为目前 针对减少TC的饮食调整的公共卫生政策 在整个人口中。 我们需要知道这样做的可能影响 在低TC的人群中，从一开始就

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.