正常血压与高血压人群中总胆固醇对心肌梗死发病长期影响的比较——首钢男性队列20年随访

目的通过对首都钢铁公司男性职工心血管病危险20年长期随访分析，比较正常血压与高血压人群，总胆固醇（TC）水平对于心肌梗死发病的影响。方法于1974、1979和1980年分三次对首都钢铁公司5137名男性职工进行基线调查，并于1982、1987、1993和2001年分别对这部分人群进行了四次随访，共随访到4986人，平均随访20．84年。将人群分为正常血压组和高血压组，使用Cox回归模型分析两组人群TC升高对于心肌梗死发病的风险，并加以比较。结果在20年长期随访中，正常血压组和高血压组男性职工，TC升高对于心肌梗死的发病均具有统计学意义；TC升高对于心肌梗死发病的风险比，在正常血压组和高血压组中分别为2．05和2．10；人群归因危险度百分比分别为23．58％和30．75％。结论TC升高作为心肌梗死的独立危险因素，在正常血压组和高血压组中均具有较强的作用，但在高血压组中其作用更加明显，有更多的心肌梗死的发病可归因于TC水平的升高。因此，为了降低冠心病心肌梗死长期发病风险，应在全人群，尤其是在高血压人群中，在控制血压的同时还应加强对TC水平的控制。

A comparison study of long term effect of total cholesterol on myocardial infarction among hypertension and non-hypertension employees in Capital Steel and Iron Company,Beijing

Objective To examine the long term effect of total cholesterol （TC） on myocardial infarction （MI） among individuals with hypertension, comparing with those without hypertension, by a cohort of 20 years follow-up in male employees in Capital Steel and Iron Company （CSIC）, Beijing, China. Methods A cohort of 5137 male employees in CSIC （ aged 18 to 74 years ） recruited from 1974 to 1980 was followed up in 1982, 1987, 1993 and 2001. The risk of MI attributable to elevated TC was assessed by Cox regression in non-hypertension and hypertension group, separately. Results Elevated TC was a significant risk factor of MI in hypertension population as well as in non-hypertension population. In non-hypertension and hypertension population, the hazard ratios of MI attributable to elevated TC were 2.05 and 2. 10, and the population attributable risk were 23.58% and 30.75%, respectively. Conclusion Elevated TC level was an important independent risk factor of MI for male adults with or without hypertension. The risk of TC on MI in hypertension population was higher than that in nonhypertension population. Treatment, and control of elevated TC is a major effort to prevent MI in male adults, especially in hypertension population.