Corti M C, Guralnik J M, Salive M E, Harris T, Field T S, Wallace R B, Berkman L F, Seeman T E, Glynn R J, Hennekens C H
Epidemiology, Demography and Biometry Program, National Institute on Aging/NIH, Bethesda, MD 20892, USA.
JAMA. 1995 Aug 16;274(7):539-44.
To examine the relationship of total cholesterol and high-density lipoprotein cholesterol (HDL-C) with coronary heart disease (CHD) mortality and with occurrence of new CHD events in persons aged 71 years and older.
Prospective cohort study with a median of 4.4 years of follow-up.
East Boston, Mass; New Haven, Conn; and Iowa and Washington counties, Iowa.
A total of 2527 women and 1377 men who completed an interview, had serum lipid determinations, and survived at least 1 year. New CHD events were evaluated in persons with no CHD history or hospitalization.
Death due to CHD (ICD-9 codes 410 through 414 as underlying cause of death); new occurrence of CHD events (fatal CHD or hospitalization with CHD [ICD-9 codes 410 through 414]).
After adjustment for established CHD risk factors, the relative risk (RR) of death due to CHD for those with low HDL-C (< 0.90 mmol/L [< 35 mg/dL]) compared with the reference group (HDL-C > or = 1.55 mmol/L [> or = 60 mg/dL]) was 2.5 (95% confidence interval [CI], 1.6 to 4.0). Elevated risk was present in subgroups aged 71 through 80 years (RR, 4.1; 95% CI, 1.9 to 8.8) and over 80 years (RR, 1.8; 95% CI, 0.99 to 3.4), and in men and women. Low HDL-C predicted an increased risk of occurrence of new CHD events (RR, 1.4; 95% CI, 1.1 to 2.0), with similar but nonsignificant results in subgroups of men and women. Total cholesterol was less consistently associated with CHD mortality than HDL-C. When we compared individuals with total cholesterol of at least 6.20 mmol/L (240 mg/dL) with the reference group with total cholesterol of 4.16 to 5.19 mmol/L (161 to 199 mg/dL), a significant risk of CHD mortality was seen for women (RR 1.8; 95% CI, 1.03 to 3.0) but not for men (RR, 1.0; 95% CI, 0.5 to 2.0). In the total population, for each 1-unit increase in the total cholesterol/HDL-C ratio there was a 17% increase in the risk of CHD death that was statistically significant.
Low HDL-C predicts CHD mortality and occurrence of new CHD events in persons older than 70 years. Elevated total cholesterol was not found to be associated with CHD mortality in older men, but may be a risk factor for CHD in older women.
研究71岁及以上人群的总胆固醇和高密度脂蛋白胆固醇（HDL-C）与冠心病（CHD）死亡率以及新发CHD事件之间的关系。
前瞻性队列研究，中位随访时间为4.4年。
马萨诸塞州东波士顿；康涅狄格州纽黑文；爱荷华州爱荷华县和华盛顿县。
共有2527名女性和1377名男性完成了访谈、进行了血脂测定且存活至少1年。对无CHD病史或住院史的人群评估新发CHD事件。
CHD导致的死亡（国际疾病分类第九版[ICD-9]编码410至414作为死亡根本原因）；新发CHD事件（致命性CHD或因CHD住院[ICD-9编码410至414]）。
在对已确定的CHD危险因素进行调整后，HDL-C水平低（<0.90 mmol/L [<35 mg/dL]）者与参照组（HDL-C≥1.55 mmol/L [≥60 mg/dL]）相比，CHD导致死亡的相对风险（RR）为2.5（95%置信区间[CI]，1.6至4.0）。71至80岁亚组（RR，4.1；95% CI，1.9至8.8）和80岁以上亚组（RR，1.8；95% CI，0.99至3.4）以及男性和女性中均存在风险升高情况。低HDL-C预示着新发CHD事件风险增加（RR，1.4；95% CI，1.1至2.0），在男性和女性亚组中结果相似但无统计学意义。总胆固醇与CHD死亡率的相关性不如HDL-C一致。当我们将总胆固醇至少为6.20 mmol/L（240 mg/dL）的个体与总胆固醇为4.16至5.19 mmol/L（161至199 mg/dL）的参照组进行比较时，女性CHD死亡率存在显著风险（RR 1.8；95% CI，1.03至3.0），而男性则无（RR，1.0；95% CI，0.5至2.0）。在总体人群中，总胆固醇/HDL-C比值每增加1个单位，CHD死亡风险增加17%，具有统计学意义。
低HDL-C预示70岁以上人群的CHD死亡率和新发CHD事件。未发现总胆固醇升高与老年男性的CHD死亡率相关，但可能是老年女性CHD的一个危险因素。
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