Goldbourt U, Holtzman E, Neufeld H N
Br Med J (Clin Res Ed). 1985 Apr 27;290(6477):1239-43. doi: 10.1136/bmj.290.6477.1239.
The association of serum total and high density lipoprotein cholesterol values with 15 year mortality was examined in a cohort of 10 059 Israeli male civil servants and municipal employees aged 40 and above. In 618 of 1664 deaths in the cohort (37%) coronary heart disease was documented as the cause of death. Risk of mortality was analysed by quintiles. Neither total mortality nor coronary heart disease mortality rose with serum cholesterol concentrations up to 5.6 mmol/1 (216 mg/100 ml), representing 60% of the sample. Rates rose appreciably only in the highest quintile (cholesterol concentration greater than 6.2 mmol/1; greater than 241 mg/100 ml). High density lipoprotein cholesterol was similarly, although inversely, associated with total mortality when expressed as a percentage of total cholesterol. The inverse association of high density lipoprotein cholesterol with coronary heart disease mortality was, in contrast, continuous. These data support the hypothesis that over most of the range of cholesterol values coronary mortality risk and total mortality risk are nearly independent of total cholesterol and most probably independent of low density lipoprotein cholesterol values. In multivariate analysis a low concentration of high density lipoprotein cholesterol appeared to be more predictive of mortality than a high concentration of total cholesterol. The latter was very weakly related to mortality from all causes after multivariate adjustment. It is concluded that the findings of this and other major epidemiological studies support the notion of a "threshold effect." Success in reducing mortality through the pharmacological reduction of serum cholesterol in hypercholesterolaemic patients does not warrant a similar approach in people with average or slightly above average values. These findings appear to provide support for a "high risk strategy" in reducing the risk of coronary heart disease.
在一个由10059名年龄在40岁及以上的以色列男性公务员和市政雇员组成的队列中，研究了血清总胆固醇和高密度脂蛋白胆固醇值与15年死亡率之间的关联。在该队列的1664例死亡病例中，有618例（37%）记录的死亡原因是冠心病。通过五分位数分析死亡率风险。在占样本60%的血清胆固醇浓度高达5.6 mmol/1（216 mg/100 ml）时，总死亡率和冠心病死亡率均未随血清胆固醇浓度升高而上升。仅在最高五分位数（胆固醇浓度大于6.2 mmol/1；大于241 mg/100 ml）时，死亡率才明显上升。当高密度脂蛋白胆固醇以占总胆固醇的百分比表示时，它与总死亡率同样呈负相关。相比之下，高密度脂蛋白胆固醇与冠心病死亡率的负相关是持续的。这些数据支持了这样一种假设，即在大多数胆固醇值范围内，冠心病死亡风险和总死亡风险几乎与总胆固醇无关，很可能也与低密度脂蛋白胆固醇值无关。在多变量分析中，低浓度的高密度脂蛋白胆固醇似乎比高浓度的总胆固醇更能预测死亡率。在多变量调整后，后者与所有原因导致的死亡率之间的关联非常微弱。得出的结论是，这项研究以及其他主要流行病学研究的结果支持了“阈值效应”这一概念。通过药物降低高胆固醇血症患者的血清胆固醇来降低死亡率的成功做法，并不适用于胆固醇值处于平均水平或略高于平均水平的人群。这些发现似乎为降低冠心病风险的“高危策略”提供了支持。
