Emond M J, Zareba W
Department of Biostatistics, University of Washington, Seattle, USA.
J Womens Health. 1997 Jun;6(3):295-307. doi: 10.1089/jwh.1997.6.295.
We assessed the short-term and long-term prognostic relationship between cholesterol and mortality in women of different ages with the aid of statistical graphics. Our population-based cohort study involved 2873 women in the Framingham Heart Study, with a median follow-up of 31 years. The primary outcome was all-cause mortality. Secondary outcome measures were coronary heart disease, noncoronary heart disease, and stroke mortality. We found that significant age interactions were present in the relationships between total cholesterol and mortality from all causes, coronary heart disease (CHD), stroke, and non-CHD causes. For women ages < or = 55, cholesterol is related positively to both short-term (p > 0.05) and long-term (p = 0.05) all-cause mortality. For women ages 56-70, there are significant U-shaped relationships between cholesterol and both short-term and long-term all-cause mortality (p < 0.01). Lowest short-term and long-term mortality rates for women in this age group are at cholesterol values between 240 and 280 mg/dl. For women ages > 70, cholesterol < 240 mg/dl is associated with increased short-term mortality (p < 0.01), and no significant long-term association was detected. These cholesterol/mortality relationships and age interactions can be explained by patterns of association between mortality and both high- and low-density lipoprotein cholesterol among women in the different age groups. These results do not support the hypothesis that cholesterol < 200 mg/dl leads to decreased mortality in women > 55 years old.
我们借助统计图表评估了不同年龄女性胆固醇与死亡率之间的短期和长期预后关系。我们基于人群的队列研究纳入了弗雷明汉心脏研究中的2873名女性,中位随访时间为31年。主要结局是全因死亡率。次要结局指标是冠心病、非冠心病和中风死亡率。我们发现,总胆固醇与全因死亡率、冠心病(CHD)、中风和非冠心病原因导致的死亡率之间的关系存在显著的年龄交互作用。对于年龄≤55岁的女性,胆固醇与短期(p>0.05)和长期(p = 0.05)全因死亡率均呈正相关。对于年龄在56 - 70岁的女性,胆固醇与短期和长期全因死亡率之间均存在显著的U型关系(p<0.01)。该年龄组女性的短期和长期死亡率最低时的胆固醇值在240至280mg/dl之间。对于年龄>70岁的女性,胆固醇<240mg/dl与短期死亡率增加相关(p<0.01),未检测到显著的长期关联。这些胆固醇/死亡率关系和年龄交互作用可以通过不同年龄组女性中死亡率与高密度脂蛋白胆固醇和低密度脂蛋白胆固醇之间的关联模式来解释。这些结果不支持胆固醇<200mg/dl会导致55岁以上女性死亡率降低这一假设。