Stamler J, Dyer A R, Shekelle R B, Neaton J, Stamler R
Department of Preventive Medicine, Northwestern University Medical School, Chicago Ill.
Cardiology. 1993;82(2-3):191-222. doi: 10.1159/000175868.
The focus here is on relationships between major risk factors and long-term mortality from coronary heart disease (CHD) and all causes, and on longevity, in Chicago cohorts: 25-year follow-up for Peoples Gas (PG) men aged 25-39 (n = 1,119), 30-year follow-up for PG men aged 40-59 (n = 1,235), 24-year follow-up for Western Electric (WE) men aged 40-55 (n = 1,882); also 15-year follow-up for five cohorts of the Chicago Heart Association (CHA) Study: men aged 25-39 (n = 7,873), 40-59 (n = 8,515), 60-74 (n = 1,490), and women aged 40-59 (n = 7,082) and 60-74 (n = 1,243); also 12-year findings for very low risk men (n = 11,098) and other men (n = 350,564) screened for the Multiple Risk Factor Intervention Trial (MRFIT). With a high degree of consistency, multivariate analyses showed independent positive relationships of baseline serum cholesterol, blood pressure and cigarette use to risk of death from CHD and all causes. For the WE cohort, with baseline nutrient data, dietary cholesterol was also independently related to these mortality risks. Combined risk factor impact was strong for both men and women of all baseline ages. Thus, for WE men, favorable compared to observed levels of serum cholesterol, blood pressure, cigarette use and dietary cholesterol were estimated to result in 24-year risk of CHD death 69% lower, all-cause death 42% lower and longevity 9 years greater. For CHA middle-aged and older women, favorable baseline levels of serum cholesterol, blood pressure and cigarette use were estimated to yield 15-year-CHD risk lower by about 60% and longevity greater by about 5 years. For MRFIT, very low risk men (serum cholesterol < 182 mg/dl, systolic/diastolic blood pressure < 120/<80), nonsmokers, nondiabetic, no previous heart attack), compared to all others, observed 12-year death rates were lower by 89% for CHD, 79% for stroke, 86% for all cardiovascular diseases, 30% for cancers, 21% for other causes, 53% for all causes, and longevity was estimated to be more than 9 years longer. These findings indicate great potentials for prevention of the CHD epidemic and for increased longevity with health for men and women, through improved life-styles and consequent lower risk factor levels.
这里重点关注芝加哥队列中主要风险因素与冠心病（CHD）及所有病因导致的长期死亡率之间的关系，以及与长寿的关系：对人民燃气公司（PG）25 - 39岁男性（n = 1119）进行25年随访，对PG 40 - 59岁男性（n = 1235）进行30年随访，对西部电气公司（WE）40 - 55岁男性（n = 1882）进行24年随访；此外，对芝加哥心脏协会（CHA）研究的五个队列进行15年随访：25 - 39岁男性（n = 7873）、40 - 59岁男性（n = 8515）、60 - 74岁男性（n = 1490）、40 - 59岁女性（n = 7082）和60 - 74岁女性（n = 1243）；还包括对多重危险因素干预试验（MRFIT）筛查的极低风险男性（n = 11098）和其他男性（n = 350564）的12年研究结果。多变量分析高度一致地显示，基线血清胆固醇、血压和吸烟与冠心病及所有病因导致的死亡风险呈独立正相关。对于WE队列，有基线营养数据，膳食胆固醇也与这些死亡风险独立相关。所有基线年龄的男性和女性，综合风险因素的影响都很强。因此，对于WE男性，与观察到的血清胆固醇、血压、吸烟和膳食胆固醇水平相比，有利水平估计可使24年冠心病死亡风险降低69%，全因死亡风险降低42%，寿命延长9年。对于CHA中年及老年女性，血清胆固醇、血压和吸烟的有利基线水平估计可使15年冠心病风险降低约60%，寿命延长约5年。对于MRFIT，极低风险男性（血清胆固醇<182 mg/dl，收缩压/舒张压<120/<80，不吸烟，非糖尿病，无既往心脏病发作）与所有其他男性相比，观察到的12年冠心病死亡率降低89%，中风死亡率降低79%，所有心血管疾病死亡率降低86%，癌症死亡率降低30%，其他病因死亡率降低21%，全因死亡率降低53%，寿命估计延长超过9年。这些发现表明，通过改善生活方式和降低风险因素水平，预防冠心病流行以及提高男性和女性的健康长寿具有巨大潜力。
