Tikhonoff Valérie, Casiglia Edoardo, Mazza Alberto, Scarpa Roberta, Thijs Lutgarde, Pessina Achille C, Staessen Jan A
Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy.
J Am Geriatr Soc. 2005 Dec;53(12):2159-64. doi: 10.1111/j.1532-5415.2005.00492.x.
To investigate the role of low-density lipoprotein cholesterol (LDL-C) as a predictor of mortality in elderly subjects.
Population-based prospective cohort study.
Two communities in northern Italy.
Three thousand one hundred twenty Caucasian subjects aged 65 and older recruited in for the Cardiovascular Study in the Elderly and followed up for 12 years.
Anthropometric measures: fasting plasma total cholesterol, triglyceride, high-density lipoprotein cholesterol, LDL-C, glucose, creatinine, and body mass index. Clinical measures: medical assessment, diabetes mellitus, hypertension, stroke, coronary disease, heart failure, and smoking and drinking habits. Vital status measures: death certificates from the Registry Office and causes of death according to the International Classification of Diseases. After plotting mortality rates using quartiles of LDL-C, relative hazard rates (RHRs) were calculated using multivariate Cox regression analyses. When the trend was nonlinear, the RHRs were further calculated for the 25th, 50th, and 75th percentiles of the distribution to confirm curvilinearity.
The distribution of risk of total mortality in women and of fatal heart failure in all subjects was curvilinear (non J-shaped), decreasing nonlinearly with LDL-C. For total mortality in men and cardiovascular mortality in both sexes, the relationship with LDL-C was J-shaped. The risk of fatal myocardial infarction was J-shaped in men, whereas it increased linearly with higher LDL-C in women. In both sexes, the association between stroke mortality and LDL-C was not significant.
This study adds to the uncertainty of the role of elevated levels of LDL-C as a risk factor for mortality in old people.
研究低密度脂蛋白胆固醇（LDL-C）作为老年受试者死亡率预测指标的作用。
基于人群的前瞻性队列研究。
意大利北部的两个社区。
3120名年龄在65岁及以上的白种人受试者，入选老年心血管研究并随访12年。
人体测量指标：空腹血浆总胆固醇、甘油三酯、高密度脂蛋白胆固醇、LDL-C、葡萄糖、肌酐和体重指数。临床指标：医学评估、糖尿病、高血压、中风、冠心病、心力衰竭以及吸烟和饮酒习惯。生命状态指标：登记处的死亡证明以及根据国际疾病分类的死因。使用LDL-C四分位数绘制死亡率曲线后，采用多变量Cox回归分析计算相对风险率（RHRs）。当趋势为非线性时，进一步计算分布的第25、50和75百分位数的RHRs以确认曲线性。
女性全因死亡率以及所有受试者致命性心力衰竭风险的分布呈曲线状（非J形），随LDL-C非线性下降。男性全因死亡率以及男女两性心血管死亡率与LDL-C的关系呈J形。男性致命性心肌梗死风险呈J形，而女性中其随LDL-C升高呈线性增加。在男女两性中，中风死亡率与LDL-C之间的关联不显著。
本研究增加了LDL-C水平升高作为老年人死亡风险因素作用的不确定性。
