McCully K S
Department of Pathology, Brown University, Providence, Rhode Island.
Am J Med Sci. 1990 Apr;299(4):217-21. doi: 10.1097/00000441-199004000-00001.
A retrospective study examined 194 consecutive autopsies to determine the proportion of cases of atherosclerosis without elevated serum cholesterol, diabetes mellitus, or hypertension. The study cases were classified into four groups, according to the cause of death and the degree of atherosclerosis. Cases in Group 1, in which death resulted from complications of severe atherosclerosis, have a mean serum cholesterol of 186.7 +/- 41.8 mg/dL, and the cholesterol is less than 200 in 65% and less than 250 in 92% of cases. Cases in Group 2, with severe atherosclerosis dying of other diseases, have a mean serum cholesterol of 174.6 +/- 60.4 mg/dL, and the cholesterol is less than 200 in 79% of cases and less than 250 in 89% of cases. Cases in Groups 3 and 4, with moderate and minimal atherosclerosis, respectively, have mean serum cholesterol values of 172.3 +/- 54.8 and 143.5 +/- 47.8 mg/dL, and the cholesterol is less than 200 in 71% and 92% and less than 250 in 92% and 96% of cases, respectively. Serum cholesterol is significantly associated with severity of atherosclerosis in the total sample (P = 0.01). Three fourths of all cases (147/194) have neither diabetes nor hypertension, and in 74% of these cases (109/147) the cholesterol is less than 200 and in 92% (135/147) the cholesterol is less than 250. In 66% (80/122) of the cases with severe atherosclerosis, the disease developed without evidence of elevated serum cholesterol, diabetes, or hypertension. Blood homocysteine, which has been shown by other studies to be an independent risk factor for atherosclerosis, is recommended for assessing prognosis in these cases.
一项回顾性研究对194例连续尸检病例进行了检查，以确定血清胆固醇未升高、无糖尿病或高血压的动脉粥样硬化病例的比例。根据死亡原因和动脉粥样硬化程度，将研究病例分为四组。第1组病例的死亡是由严重动脉粥样硬化并发症导致的，其血清胆固醇平均为186.7±41.8mg/dL，65%的病例胆固醇低于200mg/dL，92%的病例低于250mg/dL。第2组病例有严重动脉粥样硬化但死于其他疾病，其血清胆固醇平均为174.6±60.4mg/dL，79%的病例胆固醇低于200mg/dL，89%的病例低于250mg/dL。第3组和第4组病例分别有中度和轻度动脉粥样硬化，其血清胆固醇平均值分别为172.3±54.8mg/dL和143.5±47.8mg/dL，71%和92%的病例胆固醇低于200mg/dL，92%和96%的病例低于250mg/dL。在整个样本中，血清胆固醇与动脉粥样硬化严重程度显著相关（P = 0.01）。所有病例的四分之三（147/194）既无糖尿病也无高血压，其中74%（109/147）的病例胆固醇低于200mg/dL，92%（135/147）的病例胆固醇低于250mg/dL。在66%（80/122）有严重动脉粥样硬化的病例中，疾病发生时无血清胆固醇升高、糖尿病或高血压的证据。其他研究表明血同型半胱氨酸是动脉粥样硬化的独立危险因素，建议在这些病例中用于评估预后。
