Smith G D, Shipley M J, Marmot M G, Rose G
Department of Epidemiology and Population Sciences, London, England.
JAMA. 1992 Jan 1;267(1):70-6.
OBJECTIVE--To examine the relationship between plasma cholesterol concentration and mortality from major causes of death.
--Cohort study. SETTING--Civil service offices in London, England. PARTICIPANTS--There were 17,718 male civil servants aged 40 through 64 years at the time of study entry between 1967 and 1969. MAIN OUTCOME MEASURE--Mortality from major cause groups. RESULTS--There were 4022 deaths in the cohort over the 18 years of follow-up. Total mortality increased with cholesterol level, although mortality in the small group with very low cholesterol levels (5% of study population) was nonsignificantly higher (P greater than .5) than that of the remainder of the lowest quintile cholesterol group. Coronary heart disease mortality increased with increasing cholesterol concentration from the lowest levels (P less than .001 for trend). The cancer mortality rate in the group below the fifth centile of the cholesterol distribution was higher than in the remainder of the cohort for lung (P less than .001), pancreas (P = .05), liver (P = .09), and all smoking-related cancers (P = .02). Only for lung cancer was there a consistent inverse trend with cholesterol level (P less than .01). Rates of mortality due to non-neoplastic respiratory disease were inversely related to cholesterol level (P less than .001). Health state at the time of examination and socioeconomic position were related to cholesterol concentration--subjects in lower employment grades, with disease at baseline, with a history of recent unexplained weight loss, or who had been widowed had lower initial cholesterol levels. These associations largely accounted for the relationships between cholesterol level and noncardiovascular mortality. CONCLUSIONS--The inverse associations between plasma cholesterol concentration and mortality from certain causes of death seen in cohort studies could be because the participants with low cholesterol levels possess other characteristics that place them at an elevated risk of death.
目的——研究血浆胆固醇浓度与主要死因死亡率之间的关系。
设计——队列研究。
地点——英国伦敦的公务员办公室。
参与者——1967年至1969年研究开始时，有17718名年龄在40至64岁之间的男性公务员。
主要观察指标——主要死因组的死亡率。
结果——在18年的随访中，该队列中有4022人死亡。总死亡率随胆固醇水平升高而增加，尽管胆固醇水平极低的小组（占研究人群的5%）的死亡率略高于最低五分位数胆固醇组的其余人群，但差异无统计学意义（P>0.5）。冠心病死亡率随胆固醇浓度从最低水平开始升高而增加（趋势P<0.001）。胆固醇分布低于第五百分位数的组中，肺癌（P<0.001）、胰腺癌（P = 0.05）、肝癌（P = 0.09）以及所有与吸烟相关癌症（P = 0.02）的癌症死亡率高于队列其余人群。仅肺癌的死亡率与胆固醇水平呈一致的负相关趋势（P<0.01）。非肿瘤性呼吸道疾病的死亡率与胆固醇水平呈负相关（P<0.001）。检查时的健康状况和社会经济地位与胆固醇浓度有关——就业等级较低、基线时有疾病、近期有不明原因体重减轻史或丧偶的受试者初始胆固醇水平较低。这些关联在很大程度上解释了胆固醇水平与非心血管疾病死亡率之间的关系。
结论——队列研究中观察到的血浆胆固醇浓度与某些死因死亡率之间的负相关可能是因为胆固醇水平低的参与者具有其他使其死亡风险升高的特征。
