Bays Harold E, Chapman Richard H, Fox Kathleen M, Grandy Susan
Louisville Metabolic and Atherosclerosis Research Center, Louisville, KY, USA.
Curr Med Res Opin. 2008 Apr;24(4):1179-86. doi: 10.1185/030079908x280527. Epub 2008 Mar 14.
The study purpose was to compare the prevalence of dyslipidemia between a self-reported survey, Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD), and survey and laboratory data from National Health and Nutrition Examination Survey (NHANES 1999-2002).
A SHIELD questionnaire was mailed to 200,000 households representative of US adult population (64% response, n = 211,097 individuals) and included if ever diagnosed with diabetes, high blood pressure or cholesterol problems, high total cholesterol (TC), high bad cholesterol (LDL-C), low good cholesterol (HDL-C), or high triglycerides (TG). In NHANES using a combination of interviewer-administered survey and clinical and laboratory data, dyslipidemia was defined as any one of: TC > or = 240 mg/dL or diagnosis of high cholesterol; TG > 200 mg/dL; LDL-C > or = 160 mg/dL; or HDL-C < 40 mg/dL. NHANES diabetes mellitus definition was doctor diagnosis or fasting glucose > 125 mg/dL and hypertension was elevated blood pressure or taking anti-hypertensive medication. Prevalence of dyslipidemia was determined for SHIELD in 2004 and compared to NHANES 1999-2002. Prevalence of diabetes and hypertension was estimated for broader contextual comparison within cardiometabolic diseases.
In contrast to the prevalence of diabetes (8% in SHIELD and 9% in NHANES, p < 0.01) and hypertension (23% in SHIELD and 29% in NHANES, p < 0.01), dyslipidemia was reported only half as frequently in SHIELD (26%) as in NHANES (53%), p < 0.01. Components of dyslipidemia were uniformly less in SHIELD than NHANES: high TC = 17 vs. 35%, high LDL-C = 10 vs. 14%, high TG = 7 vs. 17% and low HDL-C = 5 vs. 24%; all comparisons p < 0.01.
Differences in survey methodology, non-response and timing may have impacted the comparison of SHIELD to NHANES.
Dyslipidemia prevalence was lower in self-reported SHIELD than the objectively assessed NHANES, with especially low self-report of high TG and low HDL-C. Self-reported prevalence of dyslipidemia may under-report the prevalence based on laboratory data.
本研究旨在比较自我报告调查“助力改善糖尿病风险因素的早期评估与管理研究（SHIELD）”与美国国家健康和营养检查调查（1999 - 2002年）的调查及实验室数据中血脂异常的患病率。
向代表美国成年人口的20万户家庭邮寄了SHIELD调查问卷（回复率64%，n = 211,097人），问卷内容包括是否曾被诊断患有糖尿病、高血压或胆固醇问题、总胆固醇（TC）高、低密度脂蛋白胆固醇（LDL - C）高、高密度脂蛋白胆固醇（HDL - C）低或甘油三酯（TG）高。在国家健康和营养检查调查中，采用访谈员实施的调查与临床及实验室数据相结合的方式，血脂异常被定义为以下任何一种情况：TC≥240mg/dL或被诊断为高胆固醇；TG＞200mg/dL；LDL - C≥160mg/dL；或HDL - C＜40mg/dL。国家健康和营养检查调查中糖尿病的定义为医生诊断或空腹血糖＞125mg/dL，高血压为血压升高或正在服用抗高血压药物。确定了2004年SHIELD中血脂异常的患病率，并与1999 - 2002年的国家健康和营养检查调查进行比较。为了在心血管代谢疾病范围内进行更广泛的背景比较，估计了糖尿病和高血压的患病率。
与糖尿病患病率（SHIELD中为8%，国家健康和营养检查调查中为9%，p＜0.01）和高血压患病率（SHIELD中为23%，国家健康和营养检查调查中为29%，p＜0.01）相反，SHIELD中报告的血脂异常患病率（26%）仅为国家健康和营养检查调查中（53%）的一半，p＜0.01。SHIELD中血脂异常的各项指标均比国家健康和营养检查调查中的少：高TC = 17%对35%，高LDL - C = 10%对14%，高TG = 7%对17%，低HDL - C = 5%对24%；所有比较p＜0.01。
调查方法、无应答情况和时间差异可能影响了SHIELD与国家健康和营养检查调查的比较。
自我报告的SHIELD中血脂异常患病率低于客观评估的国家健康和营养检查调查，尤其是高TG和低HDL - C的自我报告率很低。血脂异常的自我报告患病率可能低于基于实验室数据的患病率。
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