Grover S A, Levinton C, Paquet S
Centre for the Analysis of Cost-Effective Care, The Montreal General Hospital, Department of Medicine, McGill University, Quebec, Canada.
J Clin Epidemiol. 1999 Jan;52(1):49-55. doi: 10.1016/s0895-4356(98)00139-5.
The objective of this study was to develop and validate a simple clinical index to identify individuals at increased risk of an elevated CHL/HDL ratio. Using recursive partitioning, factors associated with an elevated CHL/HDL ratio were identified among 1993 men and 1631 women in the Lipid Research Clinic Prevalence Study. These factors were weighted using logistic regression analyses to develop a clinical index that was validated on 486 men and 484 women reported in the Santé Québec cardiovascular health survey. A high CHL/HDL ratio was defined as > or =5 for women and > or =6 for men which approximates the 75th percentiles reported in the second United States National Health and Nutrition Survey. In the Lipid Research Clinics cohort, 307 men (15.4%) and 188 women (11.5%) had an elevated CHL/HDL ratio. Using separate clinical indices for men and women, significant variables included body mass index, alcohol consumption, age, smoking status, systolic blood pressure, physical activity status, and the presence of diabetes, the study identified 88% of the men and 82% of the women with elevated ratios. External validation using the Santé Québec data set demonstrated test sensitivities of 81% for men and 94% for women. Overall, 12% of those with a high CHL/HDL ratio were misclassified as low risk. The ratio of total plasma cholesterol to HDL cholesterol has been shown to be one of the best lipid predictors of increased coronary risk. Readily available clinical data can be used to identify 88% of those individuals most likely to benefit from lipid screening while obviating the need for such screening in one quarter of otherwise healthy adults.
本研究的目的是开发并验证一种简单的临床指标，以识别总胆固醇（CHL）与高密度脂蛋白（HDL）比值升高风险增加的个体。利用递归划分法，在脂质研究诊所患病率研究中的1993名男性和1631名女性中确定了与CHL/HDL比值升高相关的因素。使用逻辑回归分析对这些因素进行加权，以开发一种临床指标，并在魁北克省心血管健康调查中报告的486名男性和484名女性中进行验证。女性CHL/HDL比值高定义为≥5，男性为≥6，这接近美国第二次全国健康和营养调查中报告的第75百分位数。在脂质研究诊所队列中，307名男性（15.4%）和188名女性（11.5%）的CHL/HDL比值升高。该研究使用针对男性和女性的单独临床指标，显著变量包括体重指数、饮酒量、年龄、吸烟状况、收缩压、身体活动状况以及糖尿病的存在，识别出了88%的比值升高的男性和82%的比值升高的女性。使用魁北克省数据集进行的外部验证显示，男性的测试敏感性为81%，女性为94%。总体而言，12%的CHL/HDL比值高的人被错误分类为低风险。血浆总胆固醇与HDL胆固醇的比值已被证明是冠状动脉风险增加的最佳脂质预测指标之一。现成的临床数据可用于识别88%最有可能从脂质筛查中受益的个体，同时免除四分之一原本健康的成年人进行此类筛查的必要性。
