高密度脂蛋白胆固醇与低密度脂蛋白胆固醇作为老年人冠状动脉疾病和中风的风险因素

High-density vs low-density lipoprotein cholesterol as the risk factor for coronary artery disease and stroke in old age.

作者信息

Weverling-Rijnsburger Annelies W E, Jonkers Iris J A M, van Exel Eric, Gussekloo Jacobijn, Westendorp Rudi G J

机构信息

Section of Gerontology and Geriatrics, Department of General Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands.

出版信息

Arch Intern Med. 2003 Jul 14;163(13):1549-54. doi: 10.1001/archinte.163.13.1549.

DOI:10.1001/archinte.163.13.1549

PMID:12860577

Abstract

BACKGROUND

A high total serum cholesterol level does not carry a risk of cardiovascular mortality among people 85 years and older and is related to decreased all-cause mortality. At this old age, there are few data on fractionated lipoprotein levels in the determination of cardiovascular disease risk. The aim of this study was to evaluate the relationships between low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol levels and mortality from specific causes among people in the oldest age categories.

METHODS

Between September 1, 1997, and September 1, 1999, a total of 705 inhabitants in the community of Leiden, the Netherlands, reached the age of 85 years. Among these old people, we initiated a prospective follow-up study to investigate determinants of successful aging. A total of 599 subjects participated (response rate, 87%) and all were followed up to September 2001. Serum levels of total, LDL, and HDL cholesterol were assessed at baseline along with detailed information on comorbid conditions. The main outcome measure was all-cause and specific mortality risk.

RESULTS

During 4 years of follow-up, 152 subjects died. The leading cause of death was cardiovascular disease, with similar mortality risks in all tertiles of LDL cholesterol level. In contrast, low HDL cholesterol level was associated with a 2.0-fold higher risk of fatal cardiovascular disease (95% confidence interval [CI], 1.2-3.2). The mortality risk of coronary artery disease was 2.0 (95% CI, 1.0-3.9) and for stroke it was 2.6 (95% CI, 1.0-6.6). Both low LDL cholesterol and low HDL cholesterol concentrations were associated with an increased mortality risk of infection: 2.7 (95% CI, 1.2-6.2) and 2.4 (95% CI, 1.1-5.6), respectively. The risks were unaffected by comorbidity.

CONCLUSION

In contrast to high LDL cholesterol level, low HDL cholesterol level is a risk factor for mortality from coronary artery disease and stroke in old age.

摘要

背景

血清总胆固醇水平高在85岁及以上人群中并不伴有心血管疾病死亡风险，且与全因死亡率降低有关。在这个高龄阶段，关于脂蛋白分级水平在心血管疾病风险判定中的数据很少。本研究的目的是评估低密度脂蛋白（LDL）和高密度脂蛋白（HDL）胆固醇水平与最高年龄组人群特定病因死亡率之间的关系。

方法

在1997年9月1日至1999年9月1日期间，荷兰莱顿社区共有705名居民年满85岁。在这些老年人中，我们启动了一项前瞻性随访研究，以调查成功老龄化的决定因素。共有599名受试者参与（应答率为87%），所有受试者均随访至2001年9月。在基线时评估血清总胆固醇、LDL胆固醇和HDL胆固醇水平以及合并症的详细信息。主要结局指标是全因死亡率和特定死亡率风险。

结果

在4年的随访期间，152名受试者死亡。主要死因是心血管疾病，LDL胆固醇水平的所有三分位数的死亡风险相似。相比之下，低HDL胆固醇水平与致命性心血管疾病风险高出2.0倍相关（95%置信区间[CI]，1.2 - 3.2）。冠状动脉疾病的死亡风险为2.0（95%CI，1.0 - 3.9），中风的死亡风险为2.6（95%CI，1.0 - 6.6）。低LDL胆固醇和低HDL胆固醇浓度均与感染死亡风险增加相关：分别为2.7（95%CI，1.2 - 6.2）和2.4（95%CI，1.1 - 5.6）。这些风险不受合并症影响。