J Am Board Fam Pract. 1991 Sep-Oct;4(5):285-97.
A multisite, open-label, prospective study in 327 family practices across the United States analyzed the demography of a large population of dyslipidemic patients and examined the effects of diet and exercise, as well as of gemfibrozil therapy, on serum levels of total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides.
The 3328 patients enrolled comprised a heterogenous population who had wide age range (20 to 88 years), were of both sexes and various ethnic backgrounds, and had multiple cardiac risk factors. All had a history of serum cholesterol levels of 5.17 mmol/L (200 mg/dL) or more, and some may have been previously identified as having an HDL of 1.03 mmol/L (40 mg/dL). After determining their cardiac risk factor and lipid profiles, eligible patients were assigned to a protocol of diet and exercise, followed by concomitant gemfibrozil therapy, if warranted. Treatment efficacy data will be reported in a subsequent paper.
The study population was 60 percent men. Ninety-four percent of the patients were white, 4.1 percent were black, and 1.9 percent were of other races. Women patients tended to be more overweight, and elderly women had more hypertension; they were less likely to have angina pectoris or to have had previous myocardial infarctions, angioplasty, or bypass surgery. The prevalence of low HDL cholesterol (less than 1.03 mmol/L [40 mg/dL]) was substantially higher in men. Statistically significant differences between men and women were observed for mean values of total cholesterol, 6.47 versus 6.84 mmol/L (250.3 versus 264.4 mg/dL); HDL cholesterol, 0.94 versus 1.18 mmol/L (36.3 versus 45.5 mg/dL); LDL cholesterol, 4.62 versus 4.76 mmol/L (178.7 versus 184.2 mg/dL); non-HDL cholesterol, 5.54 versus 5.66 mmol/L (214.1 versus 218.9 mg/dL); and the total cholesterol-HDL ratio, 6.84 versus 5.64.
Current National Cholesterol Education Program (NCEP) guidelines suggest lipoprotein analysis at cholesterol levels between 5.17 and 6.21 mmol/L (200 and 240 mg/dL) only if two or more risk factors are also present. Persons whose total cholesterol values are less than 6.21 mmol/L (240 mg/dL) can still be at risk because of the presence of other cardiovascular risk factors or a low level of HDL cholesterol. In this study, 74.3 percent of men and 41.3 percent of women with total cholesterol greater than or equal to 5.17 mmol/L (200 mg/dL) were also found to have a low HDL level, less than 1.03 mmol/L (40 mg/dL). The prevalence of other risk factors in this patient population was also high: 40.5 percent had hypertension, 9.6 percent had diabetes, and 20.3 percent smoked. These data suggest that routine lipoprotein analysis in the family practice setting could reveal low HDL cholesterol as an additional risk factor in a patient population where other risk factors have already been identified.
一项在美国327个家庭医生诊所开展的多中心、开放标签、前瞻性研究，分析了大量血脂异常患者的人口统计学特征，并研究了饮食、运动以及吉非贝齐治疗对血清总胆固醇、高密度脂蛋白（HDL）胆固醇、低密度脂蛋白（LDL）胆固醇和甘油三酯水平的影响。
入组的3328例患者构成了一个异质性群体，年龄范围广泛（20至88岁），包括男性和女性，具有不同种族背景，且有多种心脏危险因素。所有患者血清胆固醇水平均≥5.17 mmol/L（200 mg/dL），部分患者之前可能已被确定HDL≤1.03 mmol/L（40 mg/dL）。在确定其心脏危险因素和血脂谱后，符合条件的患者被分配至饮食和运动方案，必要时联合吉非贝齐治疗。治疗疗效数据将在后续论文中报告。
研究人群中60%为男性。94%的患者为白人，4.1%为黑人，1.9%为其他种族。女性患者往往超重更多，老年女性高血压更多；她们患心绞痛或既往有心肌梗死、血管成形术或搭桥手术的可能性较小。男性中低HDL胆固醇（<1.03 mmol/L [40 mg/dL]）的患病率显著更高。观察到男性和女性在总胆固醇均值（6.47对6.84 mmol/L [250.3对264.4 mg/dL]）、HDL胆固醇（0.94对1.18 mmol/L [36.3对45.5 mg/dL]）、LDL胆固醇（4.62对4.76 mmol/L [178.7对184.2 mg/dL]）、非HDL胆固醇（5.54对5.66 mmol/L [214.1对218.9 mg/dL]）以及总胆固醇与HDL比值（6.84对5.64）方面存在统计学显著差异。
当前国家胆固醇教育计划（NCEP）指南建议，仅当存在两个或更多危险因素时，才在胆固醇水平为5.17至6.21 mmol/L（200至240 mg/dL）之间进行脂蛋白分析。总胆固醇值<6.21 mmol/L（240 mg/dL）的人仍可能因存在其他心血管危险因素或HDL胆固醇水平低而处于风险中。在本研究中，总胆固醇≥5.17 mmol/L（200 mg/dL）的男性中有74.3%、女性中有41.3%也被发现HDL水平低，<1.03 mmol/L（40 mg/dL）。该患者群体中其他危险因素的患病率也很高：40.5%患有高血压，9.6%患有糖尿病，20.3%吸烟。这些数据表明，在家庭医生诊所进行常规脂蛋白分析可能会揭示低HDL胆固醇是已确定存在其他危险因素的患者群体中的另一个危险因素。
