Menotti A, Blackburn H, Kromhout D, Nissinen A, Fidanza F, Giampaoli S, Buzina R, Mohacek I, Nedeljkovic S, Aravanis C, Toshima H
Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, USA.
Eur Heart J. 1997 Apr;18(4):566-71. doi: 10.1093/oxfordjournals.eurheartj.a015298.
Are trends in coronary heart disease deaths based on risk factor changes?
To study the relationship between trends in coronary deaths and changes in blood cholesterol in the Seven Countries Study.
Sixteen cohorts of men aged 40-59 years from seven countries (U.S.A., Finland, the Netherlands, Italy, Croatia (former Yugoslavia), Serbia (former Yugoslavia), Greece, Japan) were units for the analyses of serum cholesterol measured at entry and after 5 and 10 years, and for mortality over 25 years.
In the populations, the ecological relationship of mean serum cholesterol at entry to late coronary heart disease death rates during the 10- to 25-year follow-up was weak, with an R-square of 0.31. Cholesterol measurements made at year 10, and an indicator of cholesterol change during the first 10 years, increased the association (R-square, 0.49). A negative and significant interaction was shown between baseline population cholesterol levels and their 10-year change. As an indicator of acceleration in mortality, cholesterol change over 10 years was also positively correlated (partial R-square 0.44) with the ratio of 25-year to 5-year deaths.
In the Seven Countries Study, late coronary heart disease death rates are largely "explained' by changes in blood cholesterol levels during the early phases of the study, mainly due to increases in lower cholesterol levels among some cohorts.
冠心病死亡趋势是否基于风险因素变化？
研究七国研究中冠心病死亡趋势与血胆固醇变化之间的关系。
来自七个国家（美国、芬兰、荷兰、意大利、克罗地亚（前南斯拉夫）、塞尔维亚（前南斯拉夫）、希腊、日本）的16组40 - 59岁男性队列作为分析对象，测定入组时、5年后和10年后的血清胆固醇水平，并分析25年期间的死亡率。
在这些人群中，入组时平均血清胆固醇水平与10至25年随访期间晚期冠心病死亡率的生态关系较弱，决定系数为0.31。第10年时的胆固醇测量值以及前10年胆固醇变化指标增强了这种关联（决定系数为0.49）。基线人群胆固醇水平与其10年变化之间存在负向且显著的交互作用。作为死亡率加速的一个指标，10年期间的胆固醇变化与25年死亡人数与5年死亡人数之比也呈正相关（偏决定系数0.44）。
在七国研究中，晚期冠心病死亡率在很大程度上可由研究早期血胆固醇水平的变化“解释”，主要原因是一些队列中较低胆固醇水平的升高。
