Assmann G, Schulte H
Institute for Clinical Chemistry and Laboratory Medicine, University of Münster, West Germany.
Am Heart J. 1988 Dec;116(6 Pt 2):1713-24. doi: 10.1016/0002-8703(88)90220-7.
The ongoing Prospective Cardiovascular Münster (PROCAM) study was initiated in 1979. The objectives of this trial were to determine the prevalence of coronary heart disease (CHD) risk factors in the German population, improve the prediction and early detection of CHD, and derive recommendations for the primary prevention of vascular disease from the trial results. Of male PROCAM trial participants, ages 40 to 65 years, who had been free of myocardial infarction or stroke at the time of entry and had been followed up for 4 years, longitudinal data analysis shows that hypertension, diabetes mellitus, and hyperlipidemia are independent risk factors for CHD. The concomitant occurrence of these factors leads to a cumulative increase in CHD risk. Hyperlipidemia is a more significant risk factor for CHD than hypertension or diabetes mellitus. Ongoing data from 4043 men and 1333 women, ages 50 to 65 years, show that more than 50% of all diabetics are hypertensive. Cholesterol is slightly increased in male hypertensives and diabetics of either sex, whereas low-density lipoprotein cholesterol is slightly raised in male hypertensives and female diabetics only. The serum triglyceride concentrations are higher for hypertensives and markedly higher for diabetics of both sexes. High-density lipoprotein cholesterol concentrations are decreased in hypertensives, especially in hypertensive women, and even more so in diabetics. The European Consensus Conference for primary prevention of CHD has classified hyperlipidemia into five groups (A to E). For hypertensives, the proportion of patients in group D (cholesterol between 200 and 300 mg/dl and triglyceride levels between 200 and 500 mg/dl) is 20.4% for men and 6.2% for women, about twice as high as those in the control groups. The occurrence of combined (group D) or massive hyperlipidemia (group E: cholesterol greater than 300 mg/dl and/or triglycerides greater than 500 mg/dl) is prevalent in more than 30% of all diabetics: two to three times more frequently than in nondiabetic patients. When concomitant hypertension is included, this prevalence increases to more than 40% for diabetic men. Among those patients endangered by three risk factors, approximately 40% of all men and 60% of all women have the particularly atherogenic combination that includes lowered high-density lipoprotein cholesterol.
正在进行的明斯特前瞻性心血管疾病（PROCAM）研究始于1979年。该试验的目的是确定德国人群中冠心病（CHD）危险因素的患病率，改善冠心病的预测和早期检测，并根据试验结果得出血管疾病一级预防的建议。对年龄在40至65岁之间、入组时无心肌梗死或中风且随访4年的男性PROCAM试验参与者进行纵向数据分析表明，高血压、糖尿病和高脂血症是冠心病的独立危险因素。这些因素同时出现会导致冠心病风险累积增加。高脂血症是比高血压或糖尿病更显著的冠心病危险因素。来自4043名男性和1333名年龄在50至65岁之间女性的持续数据显示，所有糖尿病患者中超过50%患有高血压。男性高血压患者和任何性别的糖尿病患者的胆固醇略有升高，而仅男性高血压患者和女性糖尿病患者的低密度脂蛋白胆固醇略有升高。高血压患者的血清甘油三酯浓度较高，两性糖尿病患者的血清甘油三酯浓度明显更高。高血压患者的高密度脂蛋白胆固醇浓度降低，尤其是高血压女性，糖尿病患者更是如此。欧洲冠心病一级预防共识会议将高脂血症分为五组（A至E）。对于高血压患者，D组（胆固醇在200至300mg/dl之间且甘油三酯水平在200至500mg/dl之间）患者的比例男性为20.4%，女性为6.2%，约为对照组的两倍。合并（D组）或重度高脂血症（E组：胆固醇大于300mg/dl和/或甘油三酯大于500mg/dl）在所有糖尿病患者中超过30%普遍存在：比非糖尿病患者高出两到三倍。当合并高血压时，糖尿病男性的这一患病率增至40%以上。在受三种危险因素威胁的患者中，所有男性中约40%和所有女性中60%具有特别易致动脉粥样硬化的组合，包括高密度脂蛋白胆固醇降低。
