血清胆固醇浓度降低多少以及多快能降低缺血性心脏病的风险？
By how much and how quickly does reduction in serum cholesterol concentration lower risk of ischaemic heart disease?
作者信息
Law M R, Wald N J, Thompson S G
机构信息
Department of Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, St Bartholomew's Medical College, London.
出版信息
BMJ. 1994 Feb 5;308(6925):367-72. doi: 10.1136/bmj.308.6925.367.
OBJECTIVE
To estimate by how much and how quickly a given reduction in serum cholesterol concentration will reduce the risk of ischaemic heart disease.
DESIGN
Data on the incidence of ischaemic heart disease and serum cholesterol concentration were analysed from 10 prospective (cohort) studies, three international studies in different communities, and 28 randomised controlled trials (with mortality data analysed according to allocated treatment to ensure the avoidance of bias).
MAIN OUTCOME MEASURE
Decrease in incidence of ischaemic heart disease or mortality for a 0.6 mmol/l (about 10%) decrease in serum cholesterol concentration.
RESULTS
For men results from the cohort studies showed that a decrease of serum cholesterol concentration of 0.6 mmol/l (about 10%) was associated with a decrease in incidence of ischaemic heart disease of 54% at age 40 years, 39% at age 50, 27% at 60, 20% at 70, and 19% at 80. The combined estimate from the three international studies (for ages 55-64 years) was 38% (95% confidence interval 33% to 42%), somewhat greater than the cohort study estimate of 27%. The reductions in incidence of ischaemic heart disease in the randomised trials (for ages 55-64 years) were 7% (0 to 14%) in the first two years, 22% (15% to 28%) from 2.1-5 years, and 25% (15% to 35%) after five years, the last estimate being close to the estimate of 27% for the long term reduction from the cohort studies. The data for women are limited but indicate a similar effect.
CONCLUSIONS
The results from the cohort studies, international comparisons, and clinical trials are remarkably consistent. The cohort studies, based on half a million men and 18,000 ischaemic heart disease events, estimate that a long term reduction in serum cholesterol concentration of 0.6 mmol/l (10%), which can be achieved by moderate dietary change, lowers the risk of ischaemic heart disease by 50% at age 40, falling to 20% at age 70. The randomised trials, based on 45,000 men and 4000 ischaemic heart disease events show that the full effect of the reduction in risk is achieved by five years.
目的
评估血清胆固醇浓度特定程度的降低以及降低速度对降低缺血性心脏病风险的影响。
设计
对10项前瞻性（队列）研究、3项不同社区的国际研究以及28项随机对照试验（根据分配的治疗分析死亡率数据以确保避免偏差）中的缺血性心脏病发病率和血清胆固醇浓度数据进行分析。
主要观察指标
血清胆固醇浓度降低0.6毫摩尔/升（约10%）时缺血性心脏病发病率或死亡率的下降情况。
结果
对于男性，队列研究结果显示，血清胆固醇浓度降低0.6毫摩尔/升（约10%）与40岁时缺血性心脏病发病率下降54%、50岁时下降39%、60岁时下降27%、70岁时下降20%以及80岁时下降19%相关。三项国际研究（针对55 - 64岁人群）的综合估计为38%（95%置信区间33%至42%），略高于队列研究估计的27%。随机试验中（针对55 - 64岁人群），缺血性心脏病发病率在前两年下降7%（0至14%），2.1至5年下降22%（15%至28%），5年后下降25%（15%至35%），最后一个估计值与队列研究长期降低的估计值27%接近。女性的数据有限，但显示出类似的效果。
结论
队列研究、国际比较和临床试验的结果非常一致。基于50万男性和18000例缺血性心脏病事件的队列研究估计，通过适度饮食改变可实现血清胆固醇浓度长期降低0.6毫摩尔/升（10%），这在40岁时可使缺血性心脏病风险降低50%，70岁时降至20%。基于45000名男性和4000例缺血性心脏病事件的随机试验表明，降低风险的全部效果在5年内实现。
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