Manolio T A, Furberg C D, Wahl P W, Tracy R P, Borhani N O, Gardin J M, Fried L P, O'Leary D H, Kuller L H
National Heart, Lung, and Blood Institute, Bethesda, MD.
Ann Intern Med. 1992 Apr 15;116(8):641-9. doi: 10.7326/0003-4819-116-8-641.
To assess the proportion of community-dwelling adults aged 65 years or older who are eligible for referral for lipoprotein analysis and intervention according to the National Cholesterol Education Program (NCEP) guidelines.
Cross-sectional study based on examinations and questionnaires collected in 1989 and 1990.
Four communities in the U.S. in the Cardiovascular Health Study (CHS), a study of risk factors for heart disease and stroke in older adults.
A sample of 4810 men and women ages 65 to 100 randomly selected and recruited from Health Care Financing Administration Medicare eligibility lists for the four communities; not institutionalized, not wheelchair-bound, not currently receiving therapy for cancer, not currently taking lipid-lowering medications, and not having eaten in the preceding 9 hours.
Total cholesterol and lipoprotein analysis measured in all participants.
Total cholesterol levels were less than 5.17 mmol/L (200 mg/dL) in 37% of participants, 5.17 to 6.19 mmol/L (200 to 239 mg/dL) in 39%, and 6.20 mmol/L (240 mg/dL) or greater in 24%. Compared with their counterparts, older participants, especially those over 80 years of age, were more likely to have levels below 5.17 mmol/L, as were men, nonwhites, and those with coronary heart disease or two or more coronary heart disease risk factors (P less than 0.008 for all values). Based on this screening measurement, 2174 participants were eligible for lipoprotein analysis, 80% were eligible for dietary or drug therapy using NCEP guidelines. Overall, 46% of CHS participants were eligible for lipoprotein analysis and 36% for intervention by NCEP guidelines, based on a single cholesterol measurement.
A substantial proportion of older adults in this community sample were eligible for lipoprotein analysis and intervention. Prospective studies of elderly persons are needed to determine the risk for incident coronary heart disease according to NCEP classifications and the benefits of lipid-lowering treatments in persons in this age group so that intervention strategies may best be targeted to an appropriately high-risk group.
根据美国国家胆固醇教育计划（NCEP）指南，评估年龄在65岁及以上的社区居住成年人中符合脂蛋白分析和干预转诊条件的比例。
基于1989年和1990年收集的检查和问卷进行的横断面研究。
美国心血管健康研究（CHS）中的四个社区，该研究针对老年人心脏病和中风的危险因素。
从四个社区的医疗保健财务管理局医疗保险资格名单中随机选择并招募的4810名年龄在65至100岁之间的男性和女性样本；未入住机构、不依赖轮椅、目前未接受癌症治疗、目前未服用降脂药物且在过去9小时内未进食。
对所有参与者进行总胆固醇和脂蛋白分析。
37%的参与者总胆固醇水平低于5.17 mmol/L（200 mg/dL），39%的参与者总胆固醇水平在5.17至6.19 mmol/L（200至239 mg/dL）之间，24%的参与者总胆固醇水平为6.20 mmol/L（240 mg/dL）或更高。与同龄人相比，年龄较大的参与者，尤其是80岁以上的参与者，更有可能总胆固醇水平低于5.17 mmol/L，男性、非白人以及患有冠心病或有两个或更多冠心病危险因素的参与者也是如此（所有值P均小于0.008）。基于此筛查测量，2174名参与者符合脂蛋白分析条件，80%的参与者根据NCEP指南符合饮食或药物治疗条件。总体而言，根据单次胆固醇测量，46%的CHS参与者符合脂蛋白分析条件，36%的参与者符合NCEP指南的干预条件。
该社区样本中有相当比例的老年人符合脂蛋白分析和干预条件。需要对老年人进行前瞻性研究，以根据NCEP分类确定发生冠心病的风险以及该年龄组人群降脂治疗的益处，以便干预策略能够最好地针对适当的高危人群。
