Tanne D, Yaari S, Goldbourt U
Department of Epidemiology and Preventive Medicine, Sackler School of Medicine, Tel-Aviv University, Israel.
Stroke. 1997 Jan;28(1):83-7. doi: 10.1161/01.str.28.1.83.
While there is overwhelming evidence relating low levels of HDL cholesterol (HDL-C) with coronary heart disease, the association with cerebrovascular disease is not clear. The aim of the present report was to assess the association between HDL-C levels and ischemic stroke mortality obtained from a long-term follow-up in the Israeli Ischemic Heart Disease Study.
The subjects of this report are 8586 men, tenured civil servants and municipal employees, aged 42 years or older at the time of HDL-C measurements in 1965. They were followed up for mortality for 21 years. Death due to cerebrovascular disease included the International Classification of Disease, 9th Revision, codes 430 to 438, of which presumed ischemic stroke included codes 433 to 438.
During the 21-year follow-up, 295 men died from cerebrovascular events, of which 241 deaths were due to presumed ischemic stroke. Individuals subsequently experiencing a fatal ischemic stroke had a marginally lower age-adjusted mean HDL-C (1.05 mmol/L) and a significantly lower (P < .001) age-adjusted mean percentage of serum cholesterol contained in the HDL fraction (%HDL) (19.3%) than counterparts surviving the follow-up period (1.06 mmol/L and 20.6%, respectively). Decreasing age-adjusted rates of ischemic stroke mortality were observed with increasing %HDL: 14.6, 14.0, and 11.8 per 10,000 person-years in the low, middle, and upper tertiles of %HDL, respectively. In multivariate analysis, a low concentration of HDL-C appeared to be significantly predictive of ischemic stroke mortality. The relative risk associated with a 5% decrease of %HDL was 1.18 (95% confidence interval, 1.03 to 1.34). Men at the lower tertile of HDL-C levels experienced a 1.32-fold increase of covariate-adjusted ischemic stroke mortality risk compared with counterparts at the upper tertile.
In this prospective study of middle-aged and elderly men from a healthy, working population, we have demonstrated an independent negative association between HDL-C and ischemic stroke mortality during a long-term (21-year) follow-up.
虽然有大量证据表明低水平的高密度脂蛋白胆固醇（HDL-C）与冠心病相关，但与脑血管疾病的关联尚不清楚。本报告的目的是评估HDL-C水平与以色列缺血性心脏病研究中长期随访获得的缺血性卒中死亡率之间的关联。
本报告的研究对象为8586名男性，均为终身制公务员和市政雇员，在1965年进行HDL-C测量时年龄在42岁及以上。对他们进行了21年的死亡率随访。脑血管疾病导致的死亡包括《国际疾病分类》第九版编码430至438，其中推测为缺血性卒中的包括编码433至438。
在21年的随访期间，295名男性死于脑血管事件，其中241例死亡归因于推测的缺血性卒中。随后发生致命缺血性卒中的个体，其年龄调整后的平均HDL-C略低（1.05 mmol/L），HDL部分所含血清胆固醇的年龄调整后平均百分比（%HDL）显著更低（P <.001）（19.3%），而随访期存活者分别为1.06 mmol/L和20.6%。随着%HDL升高，观察到年龄调整后的缺血性卒中死亡率降低：%HDL低、中、高三分位数组分别为每10000人年14.6、14.0和11.8例。在多变量分析中，低浓度的HDL-C似乎是缺血性卒中死亡率的显著预测因素。%HDL降低5%的相对风险为1.18（95%置信区间，1.03至1.34）。HDL-C水平处于低三分位数的男性，与处于高三分位数的男性相比，协变量调整后的缺血性卒中死亡风险增加了1.32倍。
在这项对健康在职人群中的中老年男性进行的前瞻性研究中，我们证明了在长期（21年）随访期间，HDL-C与缺血性卒中死亡率之间存在独立的负相关。
