Pocock S J, Shaper A G, Phillips A N
Department of Clinical Epidemiology and General Practice, Royal Free Hospital School of Medicine, London.
BMJ. 1989 Apr 15;298(6679):998-1002. doi: 10.1136/bmj.298.6679.998.
To assess the roles of serum concentrations of total cholesterol, high density lipoprotein cholesterol, and triglycerides in predicting major ischaemic heart disease.
Men recruited for the British regional heart study followed up for a mean of 7.5 years.
General practices in 24 British towns.
7735 Middle aged men.
Predictive value of serum concentrations of lipids.
At initial screening serum concentrations of total cholesterol, high density lipoprotein cholesterol, and triglycerides were determined from non-fasting blood samples. Altogether 443 major ischaemic heart disease events (fatal and non-fatal) occurred during the study. Men in the highest fifth of the distribution of total cholesterol concentration (greater than or equal to 7.2 mmol/l) had 3.5 times the risk of ischaemic heart disease than did men in the lowest fifth (less than 5.5 mmol/l) after adjustment for high density lipoprotein cholesterol concentration and other risk factors. Men in the lowest fifth of high density lipoprotein cholesterol concentration (less than 0.93 mmol/l) had 2.0 times the risk of men in the highest fifth (greater than or equal to 1.33 mmol/l) after adjustment for total cholesterol concentration and other risk factors. Men in the highest fifth of triglyceride concentration (greater than or equal to 2.8 mmol/l) had only 1.3 times the risk of those in the lowest fifth (less than 1.08 mmol/l) after adjustment for total cholesterol concentration and other risk factors; additional adjustment for high density lipoprotein cholesterol concentration made the association with ischaemic heart disease disappear.
Serum concentration of total cholesterol is the most important single blood lipid risk factor for ischaemic heart disease in men. High density lipoprotein cholesterol concentration is less important, and triglyceride concentrations do not have predictive importance once other risk factors have been taken into account.
评估血清总胆固醇、高密度脂蛋白胆固醇和甘油三酯浓度在预测主要缺血性心脏病方面的作用。
招募参与英国地区心脏研究的男性，平均随访7.5年。
英国24个城镇的普通诊所。
7735名中年男性。
血脂血清浓度的预测价值。
在初次筛查时，从非空腹血样中测定血清总胆固醇、高密度脂蛋白胆固醇和甘油三酯浓度。研究期间共发生443例主要缺血性心脏病事件（致命和非致命）。在调整高密度脂蛋白胆固醇浓度和其他风险因素后，总胆固醇浓度分布最高五分位数（大于或等于7.2 mmol/l）的男性患缺血性心脏病的风险是最低五分位数（小于5.5 mmol/l）男性的3.5倍。在调整总胆固醇浓度和其他风险因素后，高密度脂蛋白胆固醇浓度最低五分位数（小于0.93 mmol/l）的男性患缺血性心脏病的风险是最高五分位数（大于或等于1.33 mmol/l）男性的2.0倍。在调整总胆固醇浓度和其他风险因素后，甘油三酯浓度最高五分位数（大于或等于2.8 mmol/l）的男性患缺血性心脏病的风险仅为最低五分位数（小于1.08 mmol/l）男性的1.3倍；进一步调整高密度脂蛋白胆固醇浓度后，与缺血性心脏病的关联消失。
血清总胆固醇浓度是男性缺血性心脏病最重要的单一血脂风险因素。高密度脂蛋白胆固醇浓度的重要性较低，一旦考虑其他风险因素，甘油三酯浓度则无预测重要性。
