Olsson A G, Ekelund L G, Carlson L A
Acta Med Scand. 1975 Jul-Aug;198(1-2):55-73.
Among approximately 20,000 apparently healthy subjects whose serum cholesterol and triglyceride (TG) values were screened at a health examination, those with the most pronounced hyperlipidaemia have been selected for further studies. Thus, 188 males and 126 females, aged 30-65 years, with asymptomatic primary hyperlipoproteinaemia (HLP) and 59 male and 69 female controls with non-elevated serum lipids were studied with regard to frequency of ST segment depressions during exercise to near maximal heart rate. Furthermore, the concentrations of cholesterol and TG were determined in the lipoprotein (LP) classes very low (VLDL), low (LDL) and high (HDL) density LP, separated by preparative ultracentrifugation. From the LP analysis each subject's HLP was classified according to the typing system of HLP recommended by the WHO. The frequency of ST depressions (Minnesota code 4.1-4.3 as well as 4.1-4.4) increased with age, was higher in females than in males and was increased in all types of HLP in males. The percentage frequencies of ST depressions 4.1-4.4 in the various types of HLP were (male/female, p against controls): controls 16/36, type IIA 50 (p less than 0.01)/56, type IIB 64 (p less than 0.01)/75 (p less than 0.01)/75 (p less than 0.05), type III 67 (p less than 0.01)/33 and type IV HLP 40 (p less than 0.01/53. There was no significant difference in the frequencies of ST depressions in subjects with "high" and "low" BP (hypertensives were excluded from the study) or in subjects with "high" and "low" k-value for the i.v. glucose tolerance. Non-smokers had a tendency to higher frequencies of ST depressions than smokers. The association between different LPs and other "risk factors" and the occurrence of ST depressions in HLP were studied further with multiple regression analysis. Invariably age was the best predictor of ST depressions. The LP fraction giving the highest correlation coefficient was LDL cholesterol in both sexes. VLDL TG and LDL TG were also positively and significantly associated with ST depressions. HDL cholesterol was negatively but insignificantly correlated to ST depressions. When age and LDL cholesterol had been entered into the multiple regression, the only factor giving further significance was VLDL TG in males. Probability tables for the occurrence of ST depressions considering age and different levels of LDL cholesterol and VLDL TG were given. The importance of simultaneous consideration of both VLDL TG and LDL cholesterol in ST segment depression was evident from the tables. Of other "risk factors" (BP, glucose tollerance, smoking, ESR) entered into the regression together with only age and the LPs, only ESR contributed with borderline significance to ST depressions.
在大约20000名于健康检查中接受血清胆固醇和甘油三酯（TG）值筛查的看似健康的受试者中，挑选出血脂异常最明显的受试者进行进一步研究。因此，对188名年龄在30至65岁之间的无症状原发性高脂蛋白血症（HLP）男性和126名女性以及59名血清脂质未升高的男性和69名女性对照者进行了研究，观察他们在运动至接近最大心率时ST段压低的频率。此外，通过制备性超速离心法分离出极低密度脂蛋白（VLDL）、低密度脂蛋白（LDL）和高密度脂蛋白（HDL）等脂蛋白类别，并测定其中胆固醇和TG的浓度。根据世界卫生组织推荐的HLP分型系统，对每个受试者的HLP进行分类。ST段压低（明尼苏达编码4.1 - 4.3以及4.1 - 4.4）的频率随年龄增加，女性高于男性，且在男性的所有HLP类型中均有所增加。不同类型HLP中ST段压低4.1 - 4.4的百分比频率为（男性/女性，与对照组相比的p值）：对照组16/36，IIA型50（p < 0.01）/56，IIB型64（p < 0.01）/75（p < 0.01）/75（p < 0.05），III型67（p < 0.01）/33，IV型HLP 40（p < 0.01）/53。血压“高”和“低”的受试者（高血压患者被排除在研究之外）或静脉葡萄糖耐量“高”和“低”的受试者中，ST段压低的频率无显著差异。非吸烟者的ST段压低频率有高于吸烟者的趋势。通过多元回归分析进一步研究了不同脂蛋白与其他“危险因素”之间的关联以及HLP中ST段压低的发生情况。年龄始终是ST段压低的最佳预测指标。在两性中，相关性系数最高的脂蛋白组分都是LDL胆固醇。VLDL TG和LDL TG也与ST段压低呈正相关且具有显著意义。HDL胆固醇与ST段压低呈负相关，但无显著意义。当将年龄和LDL胆固醇纳入多元回归时，唯一具有进一步显著意义的因素是男性的VLDL TG。给出了考虑年龄以及不同LDL胆固醇和VLDL TG水平时ST段压低发生的概率表。从这些表格中可以明显看出同时考虑VLDL TG和LDL胆固醇对ST段压低的重要性。在与年龄和脂蛋白一起纳入回归的其他“危险因素”（血压、葡萄糖耐量、吸烟、红细胞沉降率）中，只有红细胞沉降率对ST段压低有边缘显著贡献。
