Kwon Daeho, Yi Jee-Jeon, Ohrr Heechoul, Yi Sang-Wook
Department of Microbiology.
Institute for Occupational and Environmental Health, Catholic Kwandong University College of Medicine, Gangneung, 25601, Republic of Korea.
Medicine (Baltimore). 2019 Sep;98(36):e17013. doi: 10.1097/MD.0000000000017013.
It is not completely clear whether "the lower, the better" cholesterol hypothesis for cardiovascular disease (CVD) and ischemic heart disease (IHD) can be applied to general populations with a low risk of heart disease mortality.We prospectively followed up 503,340 Koreans who participated in routine health checkups during 2002-2003 until 2013 via linkage to national mortality records.Nonlinear associations with total cholesterol (TC) were found: U-curves for overall CVD (I00-I99; nadir at 180-200 mg/dL) and a reverse-L-curve for IHD (I20-I25). Assuming a linear association in the lower range (<200 mg/dL), TC was inversely associated with CVD mortality (HR per 39 mg/dL [1 mmol/L] increase = 0.90). In the upper range (200-349 mg/dL), TC was positively associated with CVD mortality, largely due to IHD (HR = 1.19), especially acute myocardial infarction (HR = 1.23). The associations were generally similar in men versus women and in middle-aged (40-64 years) versus elderly (≥65 years) adults.TC levels of 180-200 mg/dL were associated with the lowest CVD mortality. Below 200 mg/dL, TC had no graded positive associations with IHD mortality. It remains unclear whether the lowest cholesterol levels are associated with the least mortality from CVD and IHD in Korean adults with a low risk of heart disease.
关于心血管疾病（CVD）和缺血性心脏病（IHD）的“胆固醇越低越好”这一假说是否适用于心脏病死亡风险较低的普通人群，目前尚不完全清楚。我们对2002年至2003年期间参加常规健康检查的503340名韩国人进行了前瞻性随访，通过与国家死亡率记录相链接，随访至2013年。研究发现总胆固醇（TC）存在非线性关联：总体CVD（I00 - I99；最低点在180 - 200mg/dL）呈U型曲线，IHD（I20 - I25）呈倒L型曲线。假设在较低范围（<200mg/dL）内呈线性关联，TC与CVD死亡率呈负相关（每增加39mg/dL[1mmol/L]的HR = 0.90）。在较高范围（200 - 349mg/dL）内，TC与CVD死亡率呈正相关，主要归因于IHD（HR = 1.19），尤其是急性心肌梗死（HR = 1.23）。男性与女性、中年（40 - 64岁）与老年（≥65岁）成年人之间的关联总体相似。180 - 200mg/dL的TC水平与最低的CVD死亡率相关。在200mg/dL以下，TC与IHD死亡率无分级正相关。目前尚不清楚在心脏病风险较低的韩国成年人中，最低的胆固醇水平是否与CVD和IHD的最低死亡率相关。
