Campbell A J, Busby W J, Robertson M C
Department of Medicine, University of Otago Medical School, Dunedin, New Zealand.
J Am Geriatr Soc. 1993 Dec;41(12):1333-8. doi: 10.1111/j.1532-5415.1993.tb06484.x.
To determine factors that characterize those 80 years and over free of clinical coronary heart disease (CHD).
Cross-sectional intergroup comparison.
Rural New Zealand town.
All those 70 years and over registered with the sole health center. Seven hundred eighty-two subjects were seen, a 91.4% response rate. Subjects were divided by World Health Organization cardiovascular questionnaire criteria, history, examination, and coded 12-lead electrocardiogram into four groups: 1) those 70-79 years of age with evidence of CHD; 2) those 80 years and older with evidence of CHD; 3) those 70-79 years of age free of CHD; and 4) those 80 years and older free of clinical CHD.
Mean values and distributions of cholesterol, high-density lipoprotein (HDL) cholesterol, apolipoproteins (apos), triglycerides, insulin, glucose, anthropometric measurements, and psychosocial variables.
In the initial analysis of variance there was a significant difference in the mean values among the four groups for body mass index (BMI), HDL cholesterol, apo A1, and triglycerides. Using the Duncan procedure, the mean value of HDL cholesterol in the group 80 years and older with no evidence of clinical CHD was significantly higher than in each of the other groups. The group 80 years and older without clinical CHD had a significantly higher mean value for apo A1 and significantly lower mean values for triglycerides and BMI than the group 70-79 years old with CHD (p < 0.05). Three-factor analysis of variance showed those free of clinical CHD had significantly higher values of HDL cholesterol (P = 0.024) and apo A1 (P = 0.022), and lower values of BMI (P = 0.017) and triglycerides (P = 0.018) compared with those who had CHD after controlling for age and sex. Those 80 years and older had lower values of BMI (P = 0.001) and triglycerides (P = 0.018) than those 70-79 years old after controlling for CHD and sex. The group who were 80 years and older and free of clinical CHD had a significantly narrower distribution of values for insulin (P < 0.001), glucose (P = 0.001), diastolic blood pressure (P = 0.001), BMI (P = 0.001), and waist-hip ratio (P = 0.002) when compared with those 80 years and older with CHD; a significantly narrower distribution of values for insulin (P = 0.024), glucose (P = 0.003), and BMI (P = 0.002) when compared with those 79-79 years old with CHD and a significantly narrower distribution of glucose (P = 0.002) and BMI (P = 0.014) when compared with those 70-79 years old and free of clinical CHD.
Those 80 years and older who were free of clinical CHD were characterized by differences in lipid and anthropometric values, particularly higher HDL cholesterol and apo A1 levels. Results were also consistent with this survivor group maintaining tighter homeostatic control over a number of variables.
确定80岁及以上无临床冠心病（CHD）者的特征因素。
横断面组间比较。
新西兰乡村小镇。
在唯一的健康中心登记的所有70岁及以上老人。共诊治782名研究对象，应答率为91.4%。根据世界卫生组织心血管病调查问卷标准、病史、体格检查以及12导联心电图编码，将研究对象分为四组：1）70 - 79岁有冠心病证据者；2）80岁及以上有冠心病证据者；3）70 - 79岁无冠心病者；4）80岁及以上无临床冠心病者。
胆固醇、高密度脂蛋白（HDL）胆固醇、载脂蛋白（apo）、甘油三酯、胰岛素、血糖、人体测量指标以及社会心理变量的均值和分布。
在初始方差分析中，四组间体重指数（BMI）、HDL胆固醇、apo A1和甘油三酯的均值存在显著差异。采用邓肯法，80岁及以上无临床冠心病证据组的HDL胆固醇均值显著高于其他各组。80岁及以上无临床冠心病组的apo A1均值显著高于70 - 79岁有冠心病组，甘油三酯和BMI均值显著低于该组（p < 0.05）。三因素方差分析显示，在控制年龄和性别后，无临床冠心病者的HDL胆固醇（P = 0.024）和apo A1（P = 0.022）值显著较高，BMI（P = 0.017）和甘油三酯（P = 0.018）值较低。在控制冠心病和性别后，80岁及以上者的BMI（P = 0.001）和甘油三酯（P = 0.018）值低于70 - 79岁者。与80岁及以上有冠心病者相比，80岁及以上无临床冠心病组的胰岛素（P < 0.001）、血糖（P = 0.001）、舒张压（P = 0.001）、BMI（P = 0.001）和腰臀比（P = 0.002）值分布显著更窄；与70 - 79岁有冠心病者相比，胰岛素（P = 0.024）、血糖（P = 0.003）和BMI（P = 0.002）值分布显著更窄；与70 - 79岁无临床冠心病者相比，血糖（P = 0.002）和BMI（P = 0.014）值分布显著更窄。
80岁及以上无临床冠心病者的特征在于脂质和人体测量指标存在差异，尤其是HDL胆固醇和apo A1水平较高。结果还表明该存活组对多个变量维持着更严格的内稳态控制。
