Woodward Mark, Martiniuk Alexandra, Lee Crystal Man Ying, Lam Tai Hing, Vanderhoorn Stephen, Ueshima Hirotsugu, Fang Xianghua, Kim Hyeon Chang, Rodgers Anthony, Patel Anushka, Jamrozik Konrad, Huxley Rachel
The George Institute for International Health, University of Sydney, Australia.
Eur J Cardiovasc Prev Rehabil. 2008 Aug;15(4):397-401. doi: 10.1097/HJR.0b013e3282fdc967.
About half of the world's cases of cardiovascular disease occur in the Asia-Pacific region. The contribution of serum total cholesterol (TC) to this burden is poorly quantified.
The most recent nationally representative data on TC distributions for countries in the region were sought. Individual participant data from 380,483 adults in the Asia Pacific Cohort Studies Collaboration were used to estimate associations between TC and cardiovascular disease.
High TC was defined as > or =6.2 mmol/l, and nonoptimal TC as > or =3.8 mmol/l. Hazard ratios for fatal coronary heart disease (CHD) and ischaemic stroke (IS) were found from Cox models. Sex-specific population attributable fractions for high TC and nonoptimal TC were estimated for each country. The former used conventional methods, based on single measures of TC and a fixed dichotomy of risk strata; the latter took account of the continuous positive association between TC and both CHD and IS and regression dilution.
Data were available from 16 countries. Where reported, the prevalence of high TC ranged from 4 to 27%. The fraction of fatal CHD and IS attributable to high TC ranged from 0 to 14% and 0 to 15%, respectively. Although leaving the relative ranking of countries much the same, the fractions estimated for nonoptimal TC were typically at least twice as big, ranging from 0 to 47% and 0 to 35%, respectively.
Conventional methods for estimating disease burden severely underestimate the effect of TC. Cholesterol-lowering strategies could have a tremendous effect in reducing cardiovascular deaths in this populous region.
全球约一半的心血管疾病病例发生在亚太地区。血清总胆固醇（TC）对这一负担的影响尚未得到充分量化。
我们收集了该地区各国关于TC分布的最新全国代表性数据。利用亚太队列研究协作组中380483名成年人的个体参与者数据来估计TC与心血管疾病之间的关联。
高TC定义为≥6.2 mmol/l，非最佳TC定义为≥3.8 mmol/l。通过Cox模型得出致命性冠心病（CHD）和缺血性中风（IS）的风险比。估计每个国家高TC和非最佳TC的性别特异性人群归因分数。前者采用基于TC单一测量值和固定风险分层二分法的传统方法；后者考虑了TC与CHD和IS之间的持续正相关以及回归稀释。
有16个国家的数据可用。据报告，高TC的患病率在4%至27%之间。高TC导致的致命性CHD和IS的比例分别在0%至14%和0%至15%之间。虽然各国的相对排名大致相同，但非最佳TC估计的比例通常至少是前者的两倍，分别在0%至47%和0%至35%之间。
估计疾病负担的传统方法严重低估了TC的影响。降低胆固醇的策略可能对减少这个人口众多地区的心血管死亡有巨大作用。
