Manolio T A, Pearson T A, Wenger N K, Barrett-Connor E, Payne G H, Harlan W R
Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, MD 20892.
Ann Epidemiol. 1992 Jan-Mar;2(1-2):161-76. doi: 10.1016/1047-2797(92)90051-q.
The value of serum total cholesterol measurement in predicting coronary heart disease (CHD) is well established in middle-aged men, but has been questioned in middle-aged women and older people of both sexes. To address this, the most recent follow-up data from 25 populations in 22 US and international cohort studies were presented and analyzed at a recent National Heart, Lung, and Blood Institute (NHLBI) workshop. Crude relative and absolute excess risks of fatal CHD were determined for individual studies and pooled across studies to determine pooled risk estimates. Serum total cholesterol and low-density-lipoprotein (LDL) cholesterol levels predicted fatal CHD in middle-aged (< 65 years) and older (> or = 65 years) men and women, though the strength and consistency of these relationships in older women were diminished. High-density-lipoprotein (HDL) cholesterol levels inversely predicted CHD in middle-aged men and women and in older women, but not in older men. Data for minority groups and for overseas populations were similar to those for white people in the United States. Relative risk estimates were generally lower for older than for middle-aged subjects, but absolute excess risk was greater. Older people and middle-aged women with elevated cholesterol levels are clearly at increased risk of coronary disease; whether this risk can be modified by dietary or drug therapy, and at what level intervention is appropriate, must not be determined.
血清总胆固醇测定在预测中年男性冠心病（CHD）方面的价值已得到充分证实，但在中年女性及两性老年人中一直受到质疑。为解决这一问题，在最近一次美国国立心肺血液研究所（NHLBI）研讨会上，展示并分析了来自美国和国际22个队列研究中25个群体的最新随访数据。针对各项研究确定了致命性冠心病的粗相对风险和绝对超额风险，并在各项研究中进行汇总以确定合并风险估计值。血清总胆固醇和低密度脂蛋白（LDL）胆固醇水平可预测中年（<65岁）及老年（≥65岁）男性和女性的致命性冠心病，不过这些关系在老年女性中的强度和一致性有所减弱。高密度脂蛋白（HDL）胆固醇水平可反向预测中年男性和女性以及老年女性的冠心病，但不能预测老年男性的冠心病。少数群体和海外人群的数据与美国白人的数据相似。老年受试者的相对风险估计值总体上低于中年受试者，但绝对超额风险更大。胆固醇水平升高的老年人和中年女性显然患冠心病的风险增加；然而，这种风险是否可以通过饮食或药物治疗加以改变，以及何种干预水平是合适的，目前尚无法确定。
