Department of Emergency Medicine, Chonnam National University Hospital, Gwangju 61469, Korea.
Laerdal Medical, 4002 Stavanger, Norway.
Int J Environ Res Public Health. 2022 Jul 6;19(14):8272. doi: 10.3390/ijerph19148272.
Numerous studies have demonstrated that abnormal levels of cholesterol are associated with a high attributable risk for the occurrence of cardiovascular disease (CVD). However, there has been no comprehensive study to investigate the relationship between serum cholesterol levels and cardiovascular mortality. Therefore, we conducted a systematic review and dose-response meta-analysis.
A systematic literature search of key databases, including EMBASE and MEDLINE, was conducted and included all the published epidemiological studies that contained estimates of the hazard ratios (HR) of serum cholesterol of CVD mortality. Data extraction, eligibility, and assessment of the risk of bias were assessed by two reviewers independently. All published risk estimates were hazard ratios and analyzed by quantitative meta-analysis using a random-effects model and dose-response relationships of serum cholesterol with CVD mortality.
A total of 14 independent reports, including 1,055,309 subjects and 9457 events, were analyzed. The pooled HR (95% CI) was 1.27 (95% CI, 1.19-1.36) for total cholesterol, 1.21 (95% CI, 1.09-1.35) for low-density lipoprotein cholesterol (LDL-C), and 0.60 (95% CI, 0.50-0.72) for high-density lipoprotein cholesterol (HDL-C). We observed a linear association between serum cholesterol (TC, HDL-C) levels and CVD mortality in this meta-analysis.
Serum total cholesterol and LDL-C level is associated with increased CVD mortality, but HDL-C level is inversely associated with CVD mortality.
许多研究表明，胆固醇水平异常与心血管疾病（CVD）发生的高归因风险有关。然而，尚未有综合研究调查血清胆固醇水平与心血管死亡率之间的关系。因此，我们进行了系统评价和剂量-反应荟萃分析。
系统检索了 EMBASE 和 MEDLINE 等主要数据库中的文献，纳入了所有包含血清胆固醇与 CVD 死亡率风险比（HR）估计值的已发表的流行病学研究。由两名评审员独立进行数据提取、合格性评估和偏倚风险评估。所有已发表的风险估计值均为 HR，并使用随机效应模型进行定量荟萃分析，并分析了血清胆固醇与 CVD 死亡率的剂量-反应关系。
共分析了 14 项独立报告，包括 1055309 名受试者和 9457 例事件。总胆固醇的合并 HR（95%CI）为 1.27（95%CI，1.19-1.36），低密度脂蛋白胆固醇（LDL-C）为 1.21（95%CI，1.09-1.35），高密度脂蛋白胆固醇（HDL-C）为 0.60（95%CI，0.50-0.72）。在这项荟萃分析中，我们观察到血清胆固醇（TC、HDL-C）水平与 CVD 死亡率之间存在线性关联。
血清总胆固醇和 LDL-C 水平与 CVD 死亡率增加相关，而 HDL-C 水平与 CVD 死亡率呈负相关。
