Department of Internal Medicine, North Karelia Central Hospital, Joensuu, Finland.
Am J Cardiol. 2011 Sep 1;108(5):677-81. doi: 10.1016/j.amjcard.2011.04.016. Epub 2011 Jun 28.
The effect of cholesterol level on the health of older people is a matter of debate, probably because of the bidirectional association. We investigated this paradox in a long-term study. The baseline assessments of the Helsinki Businessmen Study (a cohort of mainly business executives, born 1919 to 1934) included the total cholesterol value and other cardiovascular risk factors from 1964 to 1973. These men were followed up for ≤46 years (through January 2010). During the follow-up period, the cholesterol value was assessed by self-report in 2000 (n = 1,292). Mortality was ascertained from the national registers, symptoms, and health-related quality of life with RAND-36 from questionnaires in 2000. A total of 3,277 healthy men without chronic diseases at baseline were included in the analyses. The median total cholesterol concentration at baseline was 6.5 mmol/L (251 mg/dl) (interquartile range 5.8 to 7.3 mmol/L, 224 to 282 mg/dl) and, in 2000, was 5.2 mmol/L (201 mg/dl) (interquartile range 4.6 to 5.9 mmol/L, 178 to 228 mg/dl). During the follow-up period, 1,773 men (54%) died. A strong and graded relation was found between the cholesterol level and total mortality, with the men with a cholesterol level ≤4 mmol/L (154 mg/dl) having the lowest mortality. In all, the men with the lowest cholesterol gained the most life years. However, no association was found with the cholesterol level in 2000 (when 16% were using statins) and subsequent mortality. The lowest (≤4 mmol/L) cholesterol value in midlife also predicted a higher score in the physical functioning scale of RAND-36 in old age. In conclusion, a low total cholesterol value in midlife predicts both better survival and better physical functioning in old age.
胆固醇水平对老年人健康的影响是一个有争议的问题，这可能是由于双向关联。我们在一项长期研究中对此悖论进行了调查。赫尔辛基商人研究（一个主要由企业高管组成的队列，出生于 1919 年至 1934 年）的基线评估包括 1964 年至 1973 年的总胆固醇值和其他心血管危险因素。这些人被随访了≤46 年（截至 2010 年 1 月）。在随访期间，通过自我报告在 2000 年评估了胆固醇值（n=1292）。死亡率通过国家登记处、症状以及 2000 年问卷调查中的 RAND-36 健康相关生活质量来确定。共有 3277 名在基线时没有慢性疾病的健康男性被纳入分析。基线时的总胆固醇中位数浓度为 6.5 mmol/L（251 mg/dl）（四分位距 5.8 至 7.3 mmol/L，224 至 282 mg/dl），而在 2000 年，胆固醇浓度为 5.2 mmol/L（201 mg/dl）（四分位距 4.6 至 5.9 mmol/L，178 至 228 mg/dl）。在随访期间，有 1773 名男性（54%）死亡。胆固醇水平与总死亡率之间存在强烈的分级关系，胆固醇水平≤4 mmol/L（154 mg/dl）的男性死亡率最低。总体而言，胆固醇水平最低的男性获得了最多的寿命年数。然而，在 2000 年（当时 16%的人在使用他汀类药物）和随后的死亡率与胆固醇水平之间没有关联。中年时最低（≤4 mmol/L）的胆固醇值也预示着在老年时 RAND-36 的身体功能量表上获得更高的分数。总之，中年时总胆固醇值低预测老年时的生存和身体功能更好。
