Iso H, Jacobs D R, Wentworth D, Neaton J D, Cohen J D
Division of Epidemiology School of Public Health, University of Minnesota, Minneapolis 55455.
N Engl J Med. 1989 Apr 6;320(14):904-10. doi: 10.1056/NEJM198904063201405.
We examined the relation between the serum total cholesterol level and the risk of death from stroke during six years of follow-up in 350,977 men, 35 to 57 years of age, who had no history of heart attack and were not currently being treated for diabetes mellitus. The diagnosis of stroke and the type of stroke were obtained from death certificates. Using proportional-hazards regression to control for age, cigarette smoking, diastolic blood pressure, and race or ethnic group, we found that the six-year risk of death from intracranial hemorrhage (International Classification of Diseases, ninth edition [ICD-9], categories 431 and 432) was three times higher in men with serum cholesterol levels under 4.14 mmol per liter (160 mg per deciliter) than in those with higher cholesterol levels (P = 0.05 by omnibus test across five cholesterol levels). On the other hand, a positive association was observed between the serum cholesterol level and death from nonhemorrhagic stroke (P = 0.007). The inverse association of the serum cholesterol level with the risk of death from intracranial hemorrhage was confined to men with diastolic blood pressure greater than or equal to 90 mm Hg, in whom death from intracranial hemorrhage is relatively common. We conclude that there is an inverse relation between the serum cholesterol level and the risk of death from hemorrhagic stroke in middle-aged American men, but that its public health impact is overwhelmed by the positive association of higher serum cholesterol levels with death from nonhemorrhagic stroke and total cardiovascular disease (ICD-9 categories 390 through 459).
我们对350,977名年龄在35至57岁之间、无心脏病发作史且目前未接受糖尿病治疗的男性进行了为期六年的随访，研究血清总胆固醇水平与中风死亡风险之间的关系。中风的诊断及中风类型来自死亡证明。通过比例风险回归分析以控制年龄、吸烟、舒张压以及种族或族裔等因素，我们发现，血清胆固醇水平低于4.14毫摩尔/升（160毫克/分升）的男性，其颅内出血（《国际疾病分类》第九版[ICD - 9]，类目431和432）导致的六年死亡风险是胆固醇水平较高男性的三倍（在五个胆固醇水平上进行综合检验，P = 0.05）。另一方面，血清胆固醇水平与非出血性中风导致的死亡之间存在正相关（P = 0.007）。血清胆固醇水平与颅内出血死亡风险之间的负相关仅限于舒张压大于或等于90毫米汞柱的男性，在这类男性中，颅内出血导致的死亡相对常见。我们得出结论，在美国中年男性中，血清胆固醇水平与出血性中风死亡风险之间存在负相关，但较高血清胆固醇水平与非出血性中风及总心血管疾病（ICD - 9类目390至459）死亡之间的正相关对公共卫生的影响更为显著。
