中国35～64岁人群胆固醇水平与10年心血管病发病危险的前瞻性研究

目的探讨我国35～64岁人群血清总胆固醇（TC）水平与心血管病（包括急性冠心病事件和急性脑卒中事件）发病危险的关系。方法采用前瞻性队列研究的方法,对1992年建立的11省市35—64岁队列人群共30384人的基线TC水平和1992-2002年发生的急性冠心病事件和急性脑卒中事件的关系进行分析。应用Cox比例风险模型对TC水平与心血管病发病危险进行多因素分析。结果（1）以TC〈3．64mmol／L（140mg／d1）组为对照,随着TC水平的增加,缺血性心血管病发病危险呈持续增加变化。（2）TC水平与不同类型的心血管病的关系有所差别：缺血性脑卒中事件发病危险从TC很低水平（〈3．64mmol／L）开始,随着TC水平的增加呈持续上升的变化;而出血性脑卒中事件与TC水平的关系缺乏一致性。多因素分析结果显示：与TC〈5．72mmol／L（220mg／d1）相比,TC≥5．72mmol／L时急性冠心病发病危险增加74％（RR=1．743,P〈0．01）,缺血性脑卒中发病危险增加12％（RR=1．119,P〉0．05）。（3）在缺血性心血管病事件中,5．9％可归因于高TC血症;其中11．7％的急性冠心病事件和2．9％的急性缺血性脑卒中事件可归因于高TC血症。（4）不同TC水平时,随着合并其他心血管病危险因素个数的增加,10年心血管病发病的绝对危险增加。结论从TC低水平〈3．64mmol／L（140mg／dl）开始,随着TC水平的增加缺血性心血管病的发病危险持续上升。应该加强多重危险因素的综合干预,以减少心血管病的综合危险。

Serum total cholesterol and 10-year cardiovascular risk in a Chinese cohort aged 35-64 years

OBJECTIVE: To evaluate the association between serum total cholesterol (TC) and the risk of cardiovascular diseases (CVD) in subjects aged 35-64 years. METHODS: This prospective study was performed from 1992 to 2002 in 11 provinces of China and the association between baseline TC level and the development of cardiovascular diseases was analyzed in 30 384 subjects aged 35-64 years using Cox multivariate proportional hazards regression. RESULTS: (1) Compared with the group of TC < 3.64 mmol/L (140 mg/dl), multivariate-adjusted relative risk of ischemic cardiovascular disease (ICVD, including CHD and ischemic stroke) increased continuously with increasing TC level. (2) TC level was positively related to the occurrence of ischemic stroke, but not to hemorrhagic stroke. The risk of CHD increased by 74% (RR = 1.743) and the risk of ischemic stroke increased by 12% (RR = 1.119) in the group with TC > or = 5.72 mmol/L compared with the group with TC < 5.72 mmol/L (220 mg/dl). (3) High serum cholesterol was responsible to 5.9% of ICVD, 11.7% of the acute CHD and 2.9% of the acute stroke. (4) At each TC level, the 10-year risk of ICVD increased in the presence of other risk factors. CONCLUSION: Starting from TC of 3.64 mmol/L, the risk of ICVD increases continuously with increasing TC level. Multiple risk factor intervention should be strengthened to reduce the overall risk of CVD.