Gordon D J, Probstfield J L, Garrison R J, Neaton J D, Castelli W P, Knoke J D, Jacobs D R, Bangdiwala S, Tyroler H A
Lipid Metabolism-Atherogenesis Branch, National Institutes of Health, Bethesda, Maryland, MD 20892.
Circulation. 1989 Jan;79(1):8-15. doi: 10.1161/01.cir.79.1.8.
The British Regional Heart Study (BRHS) reported in 1986 that much of the inverse relation of high-density lipoprotein cholesterol (HDLC) and incidence of coronary heart disease was eliminated by covariance adjustment. Using the proportional hazards model and adjusting for age, blood pressure, smoking, body mass index, and low-density lipoprotein cholesterol, we analyzed this relation separately in the Framingham Heart Study (FHS), Lipid Research Clinics Prevalence Mortality Follow-up Study (LRCF) and Coronary Primary Prevention Trial (CPPT), and Multiple Risk Factor Intervention Trial (MRFIT). In CPPT and MRFIT (both randomized trials in middle-age high-risk men), only the control groups were analyzed. A 1-mg/dl (0.026 mM) increment in HDLC was associated with a significant coronary heart disease risk decrement of 2% in men (FHS, CPPT, and MRFIT) and 3% in women (FHS). In LRCF, where only fatal outcomes were documented, a 1-mg/dl increment in HDLC was associated with significant 3.7% (men) and 4.7% (women) decrements in cardiovascular disease mortality rates. The 95% confidence intervals for these decrements in coronary heart and cardiovascular disease risk in the four studies overlapped considerably, and all contained the range 1.9-2.9%. HDLC levels were essentially unrelated to non-cardiovascular disease mortality. When differences in analytic methodology were eliminated, a consistent inverse relation of HDLC levels and coronary heart disease event rates was apparent in BRHS as well as in the four American studies.
英国地区心脏研究（BRHS）在1986年报告称，通过协方差调整，高密度脂蛋白胆固醇（HDLC）与冠心病发病率之间的大部分反比关系被消除。我们使用比例风险模型，并对年龄、血压、吸烟、体重指数和低密度脂蛋白胆固醇进行调整，分别在弗雷明汉心脏研究（FHS）、脂质研究临床患病率死亡率随访研究（LRCF）、冠心病一级预防试验（CPPT）和多重危险因素干预试验（MRFIT）中分析了这种关系。在CPPT和MRFIT（两项针对中年高危男性的随机试验）中，仅对对照组进行了分析。HDLC每增加1mg/dl（0.026mM），男性（FHS、CPPT和MRFIT）的冠心病风险显著降低2%，女性（FHS）降低3%。在LRCF中，仅记录了致命结局，HDLC每增加1mg/dl，心血管疾病死亡率显著降低3.7%（男性）和4.7%（女性）。这四项研究中冠心病和心血管疾病风险降低的95%置信区间有相当大的重叠，且均包含1.9 - 2.9%的范围。HDLC水平与非心血管疾病死亡率基本无关。当消除分析方法的差异后，HDLC水平与冠心病事件发生率之间一致的反比关系在BRHS以及四项美国研究中都很明显。
