Di Mascio R, Marchioli R, Vitullo F, Di Pasquale A, Cavasinni L, Tognoni G
Laboratory of Clinical Pharmacology and Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri, Consorzio Mario Negri Sud, Chieti, Italy.
Prev Med. 1995 Mar;24(2):128-33. doi: 10.1006/pmed.1995.1025.
While a positive relation between serum cholesterol and the risk of myocardial infarction has been consistently reported, the association between serum cholesterol and the risk of ischemic stroke lacks consistency. To further investigate the strength of cholesterol as a risk factor for myocardial infarction and stroke we conducted a comparative study.
A case-control study was conducted from 1990 to 1992. A network of 21 hospitals in Abruzzo, southern Italy, was created. First, computerized tomography scans confirmed ischemic stroke patients (230 with median age: 64; range: 31-69 years) and 230 sex- and age-matched controls with acute disorders unrelated to known cardiovascular risk factors. Acute myocardial infarction patients (513) and 513 matched controls were simultaneously recruited for a parallel study comparison. Total serum cholesterol concentration was measured within the first 48 hr following admission and the response to a structured questionnaire was evaluated.
The mean (standard deviation) serum cholesterol level was 220.7 mg/dl (50.9) among stroke patients and 201.5 mg/dl (41.6) among controls (P < 0.0001). Compared with the lowest quintile (< 160 mg/dl), the odds ratio of ischemic stroke for patients in the highest quintile (> 240 mg/dl), after simultaneous adjustment for other potentially confounding covariates, was 2.6 (95% confidence interval: 1.4-4.8). A significant linear trend in risk was found (chi 2 1 df = 7.27, P < 0.01). Within each total serum cholesterol quintile, adjusted odds ratios for myocardial infarction were higher than that for ischemic stroke, and a stronger linear trend in risk was found (chi 2 1 df = 21.3, P < 0.0001).
Our data confirm the strong linear relationship between total serum cholesterol and the risk of myocardial infarction and suggest that, at least in our population, cholesterol seems to be an indicator of ischemic stroke risk.
虽然血清胆固醇与心肌梗死风险之间的正相关关系已有一致报道，但血清胆固醇与缺血性中风风险之间的关联却缺乏一致性。为进一步研究胆固醇作为心肌梗死和中风风险因素的强度，我们开展了一项比较研究。
1990年至1992年进行了一项病例对照研究。在意大利南部阿布鲁佐建立了一个由21家医院组成的网络。首先，计算机断层扫描确诊了缺血性中风患者（230例，中位年龄：64岁；范围：31 - 69岁）以及230名性别和年龄匹配、患有与已知心血管危险因素无关的急性疾病的对照者。同时招募了急性心肌梗死患者（513例）和513名匹配对照者进行平行研究比较。入院后48小时内测量总血清胆固醇浓度，并评估对一份结构化问卷的回答。
中风患者的平均（标准差）血清胆固醇水平为220.7mg/dl（50.9），对照者为201.5mg/dl（41.6）（P < 0.0001）。与最低五分位数（<160mg/dl）相比，在对其他潜在混杂协变量进行同时调整后，最高五分位数（>240mg/dl）患者发生缺血性中风的比值比为2.6（95%置信区间：1.4 - 4.8）。发现风险存在显著的线性趋势（卡方检验，1自由度 = 7.27，P < 0.01）。在每个总血清胆固醇五分位数内，心肌梗死的调整后比值比高于缺血性中风，且发现风险有更强的线性趋势（卡方检验，1自由度 = 21.3，P < 0.0001）。
我们的数据证实了总血清胆固醇与心肌梗死风险之间存在强线性关系，并表明至少在我们的研究人群中，胆固醇似乎是缺血性中风风险的一个指标。
