Burke G L, Sprafka J M, Folsom A R, Hahn L P, Luepker R V, Blackburn H
Department of Public Health Sciences, Bowman Gray School of Medicine, Winston-Salem, NC 27103.
N Engl J Med. 1991 Apr 4;324(14):941-6. doi: 10.1056/NEJM199104043241402.
We assessed community trends in the awareness, treatment, and control of hypercholesterolemia (defined as a serum cholesterol level greater than 6.21 mmol per liter [240 mg per deciliter]) during the 1980s in the Minneapolis-St. Paul (Twin Cities) metropolitan area. Twin Cities residents 25 to 74 years old participated in independent, cross-sectional, population-based surveys of risk factors for cardiovascular disease in 1980-1982 (n = 3365) and 1985-1987 (n = 4545).
Mean serum total cholesterol levels, as adjusted for age, decreased significantly (P less than 0.01) from 1980-1982 to 1985-1987 in men (from 5.30 mmol per liter [205 mg per deciliter] to 5.16 mmol per liter [200 mg per deciliter]) and women (from 5.19 mmol per liter [201 mg per deciliter] to 5.04 mmol per liter [195 mg per deciliter]). The prevalence of hypercholesterolemia as adjusted for age decreased significantly (P less than 0.05) in men (17.8 to 15.1 percent) and women (17.1 to 13.6 percent). The ratio of total cholesterol to high-density lipoprotein (HDL) cholesterol was unchanged during this period, because of a concurrent decline in the level of HDL cholesterol. Participants with hypercholesterolemia in the 1985-1987 survey were more likely than those in the 1980-1982 survey to be aware of their condition (32.6 vs. 25.4 percent), to be treated with lipid-lowering agents (4.3 vs. 1.9 percent), and to have their condition controlled (1.9 vs. 0.3 percent). Among those who reported treatment by a physician for hyperlipidemia, changes were observed in the type of treatment recommended. A significant increase (P less than 0.05) was noted from 1980-1982 to 1985-1987 in the percentage of men being treated for hyperlipidemia with lipid-lowering medication (5.2 vs. 11.6 percent) and with exercise programs (10.3 vs. 20.1 percent). In women being treated for hyperlipidemia, a nonsignificant increase was noted in the use of lipid-lowering medication (8.2 vs. 13.9 percent), and a significant increase (P less than 0.05) was observed in the number of exercise prescriptions (4.1 vs. 12.0 percent).
We found a substantial decline in the prevalence of hypercholesterolemia in the Twin Cities between 1980-1982 and 1985-1987 that may be attributed to changes in lifestyle, such as diet and exercise, and to a lesser extent to more aggressive intervention with lipid-lowering drugs by physicians.
我们评估了20世纪80年代明尼阿波利斯 - 圣保罗（双城）都会区高胆固醇血症（定义为血清胆固醇水平高于6.21毫摩尔/升[240毫克/分升]）的知晓率、治疗率和控制率的社区趋势。双城25至74岁的居民参与了1980 - 1982年（n = 3365）和1985 - 1987年（n = 4545）基于人群的心血管疾病危险因素独立横断面调查。
经年龄调整后，男性（从5.30毫摩尔/升[205毫克/分升]降至5.16毫摩尔/升[200毫克/分升]）和女性（从5.19毫摩尔/升[201毫克/分升]降至5.04毫摩尔/升[195毫克/分升]）的平均血清总胆固醇水平从1980 - 1982年到1985 - 1987年显著下降（P < 0.01）。经年龄调整后的高胆固醇血症患病率在男性（从17.8%降至15.1%）和女性（从17.1%降至13.6%）中显著下降（P < 0.05）。在此期间，总胆固醇与高密度脂蛋白（HDL）胆固醇的比值未变，因为HDL胆固醇水平同时下降。1985 - 1987年调查中患有高胆固醇血症的参与者比1980 - 1982年调查中的参与者更有可能知晓自己的病情（32.6%对25.4%）、接受降脂药物治疗（4.3%对1.9%）以及病情得到控制（1.9%对0.3%）。在那些报告由医生治疗高脂血症的人中，观察到了推荐治疗类型的变化。从1980 - 1982年到1985 - 1987年，接受降脂药物治疗高脂血症的男性百分比（5.2%对11.6%）和接受运动计划治疗的男性百分比（10.3%对20.1%）显著增加（P < 0.05）。在接受高脂血症治疗的女性中，降脂药物的使用有不显著增加（8.2%对13.9%），运动处方数量显著增加（P < 0.05）（4.1%对12.0%）。
我们发现1980 - 1982年至1985 - 1987年期间双城高胆固醇血症的患病率大幅下降，这可能归因于生活方式（如饮食和运动）的改变，以及医生对降脂药物更积极的干预，但程度较小。
