D'Agostino R B, Belanger A J, Kannel W B, Higgins M
Department of Mathematics, Boston University, MA 02215, USA.
Am J Epidemiol. 1995 May 1;141(9):822-7. doi: 10.1093/oxfordjournals.aje.a117517.
Elevated mortality has been reported at extremes of the serum total cholesterol distribution, with increased coronary mortality reported at high total cholesterol levels and increased cancer and non-cardiovascular/non-cancer mortality at low total cholesterol levels. The authors used data collected on 1,959 males aged 35-69 years from the fourth Framingham Study examination to analyze the relations between total serum cholesterol levels and 409 coronary deaths, 325 cancer deaths, and 534 other deaths for a 32-year follow-up. Age- and risk factor-adjusted Cox regressions were computed. Nonlinear (U-shaped) relations were investigated with the use of quadratic regression and with dummy variables using the 160-199 mg/dl group as the comparison group. Subset analyses investigated the relation in smokers and men who drank > or = 14 alcoholic drinks per week. All analyses were repeated removing those with existing cardiovascular disease and cancer and those who died during the first 5 years of follow-up. A significant U-shaped relation with all-cause mortality was noted, as were an inverse relation to cancer mortality and a monotonic increasing relation with coronary disease mortality. In subset analyses, the association of low serum cholesterol (< 160 mg/dl) with cancer mortality was observed in men who smoked cigarettes. Compared with the 160-199 mg/dl group, the relative risk was 3.72 (p = 0.0001, 95% confidence interval 1.91-7.25). Studies of the relation of low total serum cholesterol levels, cigarette smoking, and cancer are needed.
据报道，在血清总胆固醇分布的两端死亡率升高，总胆固醇水平高时冠心病死亡率增加，总胆固醇水平低时癌症及非心血管/非癌症死亡率增加。作者利用从弗明汉姆心脏研究第四次检查中收集的1959名年龄在35 - 69岁男性的数据，分析血清总胆固醇水平与32年随访期间409例冠心病死亡、325例癌症死亡和534例其他死亡之间的关系。计算了年龄和风险因素调整后的Cox回归。使用二次回归以及以160 - 199mg/dl组作为对照组的虚拟变量研究非线性（U型）关系。亚组分析研究了吸烟者以及每周饮用≥14杯酒精饮料的男性中的关系。所有分析在剔除已患心血管疾病和癌症者以及随访前5年期间死亡者后重复进行。发现全因死亡率呈显著U型关系，癌症死亡率呈负相关，冠心病死亡率呈单调递增关系。在亚组分析中，观察到吸烟男性中低血清胆固醇（<160mg/dl）与癌症死亡率有关联。与160 - 199mg/dl组相比，相对风险为3.72（p = 0.0001，95%置信区间1.91 - 7.25）。需要开展关于低血清总胆固醇水平、吸烟与癌症关系的研究。
