Cremer P, Muche R
Klinikum Grosshadern, Ludwig-Maximilians-Universität, München, Institut für Klinische Chemie.
Ther Umsch. 1990 Jun;47(6):482-91.
The Göttingen Risk-, Incidence- and Prevalence Study (abbreviated GRIPS) consists of several epidemiological projects, among which project B is currently the most important one. Project B is a prospective cohort study, which was started in 1982 by a baseline investigation, including approximately 6000 men aged 40 to 60 years. Follow-up investigations were performed in 1985 and 1987 in order to record reasons of death and incidences of newly developed diseases. Further follow-up investigations are planned for 1990 and 1992. Until now incidence data of death and diseases are available for a 5-year observation period (January 1982-December 1986), and for more than 95% of the original study participants. The results clearly indicate that plasma levels of LDL-cholesterol, followed by plasma concentrations of total cholesterol and apoprotein B are the predominant predictors for the risk of coronary artery diseases (CAD; i.e. fatal and non fatal myocardial infarction as well as sudden coronary death and chronic coronary heart disease). Further significantly positive associations to the incidence of myocardial infarction (MI) were found for the following parameters: Systolic and diastolic blood pressure, family history of premature MI, cigarette smoking, plasma levels of triglycerides, VLDL-cholesterol and blood glucose. Plasma concentrations of HDL-cholesterol and apo A1 showed an inverse relationship to the MI incidence and--somewhat weaker--the same was true for the frequency of alcohol consumption and of physical leisure activity. Besides LDL-cholesterol, total cholesterol and apoprotein B the following parameters showed significantly positive associations to the risk of chronic coronary heart disease: Systolic as well as diastolic blood pressure and--to a lesser extent--the plasma levels of triglycerides, VLDL-cholesterol and blood glucose. An inverse relationship to the incidence rate of chronic coronary heart disease was found for HDL-cholesterol, apo A1 and the frequency of physical leisure activity. Based on the epidemiological results from GRIPS, additionally considering results from other epidemiologic studies and pathophysiological findings a diagnostic strategy was developed for the early recognition of patients at increased coronary risk. LDL-cholesterol is the most important variable in this diagnostic schedule but the coronary status and the individual profile of further risk factors (i.e. positive family history of premature myocardial infarction, hypertension, diabetes mellitus, cigarette smoking, increased plasma levels of triglyceride rich lipoproteins or Lp(a) as well as decreased plasma concentrations of HDL-cholesterol or apo A1) are additionally taken into account.
哥廷根风险、发病率和患病率研究（简称GRIPS）由多个流行病学项目组成，其中项目B是目前最重要的一个。项目B是一项前瞻性队列研究，于1982年通过基线调查启动，包括约6000名40至60岁的男性。1985年和1987年进行了随访调查，以记录死亡原因和新发病例。计划在1990年和1992年进行进一步的随访调查。到目前为止，已有5年观察期（1982年1月至1986年12月）且针对超过95%的原始研究参与者的死亡和疾病发病率数据。结果清楚地表明，低密度脂蛋白胆固醇的血浆水平，其次是总胆固醇和载脂蛋白B的血浆浓度，是冠状动脉疾病（CAD，即致命和非致命性心肌梗死以及心源性猝死和慢性冠心病）风险的主要预测指标。对于以下参数，还发现与心肌梗死（MI）发病率有显著正相关：收缩压和舒张压、早发MI家族史、吸烟、甘油三酯血浆水平、极低密度脂蛋白胆固醇和血糖。高密度脂蛋白胆固醇和载脂蛋白A1的血浆浓度与MI发病率呈负相关，对于饮酒频率和体育休闲活动频率，这种负相关关系稍弱。除了低密度脂蛋白胆固醇、总胆固醇和载脂蛋白B外，以下参数与慢性冠心病风险也有显著正相关：收缩压和舒张压，以及在较小程度上，甘油三酯、极低密度脂蛋白胆固醇和血糖的血浆水平。发现高密度脂蛋白胆固醇、载脂蛋白A1和体育休闲活动频率与慢性冠心病发病率呈负相关。基于GRIPS的流行病学结果，再结合其他流行病学研究结果和病理生理学发现，制定了一种诊断策略，用于早期识别冠心病风险增加的患者。低密度脂蛋白胆固醇是该诊断方案中最重要的变量，但冠状动脉状况以及其他风险因素的个体特征（即早发心肌梗死家族史阳性、高血压、糖尿病、吸烟、富含甘油三酯脂蛋白或Lp(a)的血浆水平升高以及高密度脂蛋白胆固醇或载脂蛋白A1的血浆浓度降低）也会被额外考虑在内。
