Lloyd-Jones Donald M, Wilson Peter W F, Larson Martin G, Leip Eric, Beiser Alexa, D'Agostino Ralph B, Cleeman James I, Levy Daniel
National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA 01702, USA.
Arch Intern Med. 2003 Sep 8;163(16):1966-72. doi: 10.1001/archinte.163.16.1966.
We sought to assess how cholesterol levels at different ages modify the remaining lifetime risk of coronary heart disease (CHD).
We included all Framingham Heart Study participants examined from 1971 through 1996 who did not have CHD and were not receiving lipid-lowering therapy. At index ages of 40, 50, 60, 70, and 80 years, participants were stratified by total cholesterol level and by cholesterol subfractions. Lifetime risk of CHD was calculated with death free of CHD as a competing event.
Among 3269 men and 4019 women, 1120 developed CHD and 1365 died free of CHD during follow-up. At each index age, lifetime risk of CHD increased with higher cholesterol levels, and time to event decreased. At age 40 years, the lifetime risks of CHD through age 80 years for men with total cholesterol levels less than 200 mg/dL (<5.20 mmol/L), 200 to 239 mg/dL (5.20-6.19 mmol/L), and 240 mg/dL or greater (> or =6.20 mmol/L), respectively, were 31%, 43%, and 57%; for women, the lifetime risks were 15%, 26%, and 33%, respectively. Lifetime risks contrasted sharply with shorter-term risks: at age 40 years, the 10-year cumulative risks of CHD were 3%, 5%, and 12% for men, and 1%, 2%, and 5% for women, respectively.
Lifetime risk of CHD increases sharply with higher total cholesterol levels for men and women at all ages. These data support an important role for cholesterol screening in younger patients, and they may help target high-risk patients for lifestyle modification or drug therapy.
我们试图评估不同年龄的胆固醇水平如何改变冠心病（CHD）的剩余终生风险。
我们纳入了1971年至1996年接受检查的所有弗雷明汉心脏研究参与者，这些参与者没有冠心病且未接受降脂治疗。在40、50、60、70和80岁的索引年龄时，参与者按总胆固醇水平和胆固醇亚组分进行分层。以无冠心病死亡作为竞争事件计算冠心病的终生风险。
在3269名男性和4019名女性中，1120人在随访期间患冠心病，1365人无冠心病死亡。在每个索引年龄，冠心病的终生风险随着胆固醇水平升高而增加，事件发生时间缩短。在40岁时，总胆固醇水平低于200mg/dL（<5.20mmol/L）、200至239mg/dL（5.20 - 6.19mmol/L）和240mg/dL及以上（≥6.20mmol/L）的男性，到80岁时冠心病的终生风险分别为31%、43%和57%；女性的终生风险分别为15%、26%和33%。终生风险与短期风险形成鲜明对比：在40岁时，男性冠心病的10年累积风险分别为3%、5%和12%，女性分别为1%、2%和5%。
所有年龄段的男性和女性，冠心病的终生风险都随着总胆固醇水平升高而急剧增加。这些数据支持在年轻患者中进行胆固醇筛查的重要作用，并且可能有助于确定高危患者进行生活方式改变或药物治疗。
