Grover S A, Palmer C S, Coupal L
Centre for the Analysis of Cost-Effective Care, Montreal Quebec General Hospital.
Arch Intern Med. 1994 Mar 28;154(6):679-84.
To assess the accuracy of specific plasma lipid fractions in predicting coronary heart disease (CHD) mortality among adults.
Follow-up data for a random sample of 30- to 79-year-old men and women recruited into the Lipid Research Clinics Prevalence and Follow-up Studies were included in this analysis (n = 4499). Baseline measurements of total plasma cholesterol and lipoprotein fractions were compared with subsequent CHD mortality after a mean follow-up of 12.3 years. The areas under receiver operating characteristics curves for specific serum lipids were compared for individuals aged 30 to 59 and 60 to 79 years.
For the younger cohort, the ratio of total cholesterol to high-density lipoprotein cholesterol was a better predictor (P < .05) of CHD mortality (receiver operating characteristic curve area, 0.80 +/- 0.03) than was total cholesterol level alone (receiver operating characteristic curve area, 0.73 +/- 0.03) or any other single lipoprotein measurement. Among the older cohort, the same screening strategies performed poorly, with receiver operating characteristic curve areas ranging from 0.51 +/- 0.05 for total cholesterol to 0.64 +/- 0.05 for the ratio of low-density to high-density lipoprotein cholesterol levels.
Plasma lipid levels are poor predictors of coronary death among those aged 60 to 79 years without known CHD. These data indicate the need to define better lipid screening strategies for older, asymptomatic adults. Among younger adults aged 30 to 59 years, high-density lipoprotein cholesterol measurement should be included as part of any lipid screening program, as the ratio of total to high-density lipoprotein cholesterol levels is the best lipid screening test to identify those at high risk for subsequent CHD mortality.
评估特定血浆脂质组分预测成人冠心病（CHD）死亡率的准确性。
本分析纳入了脂质研究临床患病率和随访研究中随机抽取的30至79岁男性和女性的随访数据（n = 4499）。将血浆总胆固醇和脂蛋白组分的基线测量值与平均随访12.3年后的后续CHD死亡率进行比较。比较了30至59岁和60至79岁个体特定血清脂质的受试者工作特征曲线下面积。
对于较年轻的队列，总胆固醇与高密度脂蛋白胆固醇的比值是CHD死亡率更好的预测指标（P <.05）（受试者工作特征曲线面积，0.80±0.03），优于单独的总胆固醇水平（受试者工作特征曲线面积，0.73±0.03）或任何其他单一脂蛋白测量值。在较年长的队列中，相同的筛查策略表现不佳，受试者工作特征曲线面积从总胆固醇的0.51±0.05到低密度与高密度脂蛋白胆固醇水平比值的0.64±0.05不等。
在60至79岁无已知CHD的人群中，血浆脂质水平对冠状动脉死亡的预测能力较差。这些数据表明需要为年龄较大、无症状的成年人定义更好的脂质筛查策略。在30至59岁的较年轻成年人中，应将高密度脂蛋白胆固醇测量纳入任何脂质筛查项目，因为总胆固醇与高密度脂蛋白胆固醇水平的比值是识别后续CHD死亡高危人群的最佳脂质筛查测试。
