Mahley Robert W, Can Selçuk, Ozbayrakçi Sinan, Bersot Thomas P, Tanir Sibel, Palaoğlu K Erhan, Pépin Guy M
Gladstone Institute of Cardiovascular Disease, San Francisco, California.
Am J Cardiol. 2005 Aug 15;96(4):547-55. doi: 10.1016/j.amjcard.2005.04.018.
The extent to which high-density lipoprotein (HDL) cholesterol levels can be increased in patients with low HDL cholesterol is important because low HDL cholesterol levels increase the risk of coronary heart disease (CHD). During the past 14 years, we have assessed risk factors in Turks, a population in which extremely low HDL cholesterol levels (mean 36 mg/dl in men, 42 mg/dl in women) are a prime CHD risk factor. Although genetically determined to a significant extent, these low HDL cholesterol levels can be modulated by lifestyle factors, as in other populations. We measured the HDL cholesterol levels in men and women residing in Istanbul at 3 time points: 1990 to 1993, 1996 to 2000, and 2003. The mean HDL cholesterol levels increased from 45.3 +/- 9.5 mg/dl in 1990 to 1993 to 49.7 +/- 12 mg/dl in 2003 (p <0.0001) in women, but were virtually unchanged in men (38 +/- 8 vs 39 +/- 10 mg/dl). In contrast to previous years, the HDL cholesterol levels in women in 2003 were markedly affected by education level and socioeconomic status, averaging 56 +/- 9 mg/dl in those with a university education and 48 +/- 12 mg/dl in those with a primary school education. Part of this difference could be explained by less smoking and more exercise and lower body mass index (average 25.6 +/- 4.9 vs 29.7 +/- 5.1 kg/m(2)) of the highly educated women. It is important to note the increase in the prevalence of obesity between the 1990 to 1993 interval and 2003 in men and women, including a remarkable change from 9.4% to 45.2% among women with a primary school education. None of these factors affected the HDL cholesterol levels of men by >2 mg/dl at any of the 3 points. In conclusion, because CHD risk changes by as much as 2% to 4% per 1 mg/dl difference in HDL cholesterol level, the 8 mg/dl difference may reflect as much as a 20% to 30% reduction in CHD risk associated with the benefit of higher education in women. Why education failed to affect the HDL cholesterol levels in Turkish men remains unclear.
高密度脂蛋白（HDL）胆固醇水平在低HDL胆固醇患者中能够升高的程度很重要，因为低HDL胆固醇水平会增加冠心病（CHD）风险。在过去14年里，我们评估了土耳其人群的风险因素，在该人群中，极低的HDL胆固醇水平（男性平均为36mg/dl，女性平均为42mg/dl）是主要的冠心病风险因素。尽管在很大程度上由基因决定，但这些低HDL胆固醇水平可像在其他人群中一样，受到生活方式因素的调节。我们在三个时间点测量了居住在伊斯坦布尔的男性和女性的HDL胆固醇水平：1990年至1993年、1996年至2000年以及2003年。女性的HDL胆固醇平均水平从1990年至1993年的45.3±9.5mg/dl升至2003年的49.7±12mg/dl（p<0.0001），而男性则基本未变（38±8mg/dl对39±10mg/dl）。与前几年不同，2003年女性的HDL胆固醇水平受教育程度和社会经济地位影响显著，大学学历女性平均为56±9mg/dl，小学学历女性平均为48±12mg/dl。这种差异部分可归因于高学历女性吸烟较少、运动较多且体重指数较低（平均25.6±4.9kg/m²对29.7±5.1kg/m²）。值得注意的是，1990年至1993年期间与2003年相比，男性和女性肥胖患病率均有所上升，小学学历女性的肥胖患病率从9.4%显著升至45.2%。在这三个时间点中的任何一个，这些因素对男性HDL胆固醇水平的影响均未超过2mg/dl。总之，由于HDL胆固醇水平每相差1mg/dl，冠心病风险变化高达2%至4%，8mg/dl的差异可能反映出与女性受高等教育相关的冠心病风险降低了20%至30%。教育为何未能影响土耳其男性的HDL胆固醇水平尚不清楚。
