老年男性冠心病人群总胆固醇水平与全因死亡的相关性研究

Relationship between serum total cholesterol level and all cause mortality in the population of senile male with coronary artery disease

目的探讨老年男性冠心病人群总胆固醇（TC）水平与全因死亡的关系。方法连续入选878例65~86岁的男性冠心病患者,按基线TC水平分为4组：组1（TC〈4.16 mmol/L）、组2（4.16≤TC〈4.68 mmol/L）、组3（4.68 mmol/L≤TC〈5.2 mmol/L）、组4（TC≥5.2 mmol/L）,应用Cox比例风险模型对TC与1996年~2007年间发生的全因死亡进行多因素分析。结果 （1）老年男性冠心病人群的最主要死因是冠心病,占31.30%;（2）与组1相比,组2、组3、组4的全因死亡相对风险分别降低了33%、19%、33%;（3）在≥75岁人群中,高TC血症组（组4）的全因死亡相对危险较组1降低13%;（4）Coxs比例风险模型分析显示,在老年男性冠心病人群中,年龄、吸烟、饮酒、空腹血糖、高血压病史是全因死亡的危险因素,降脂治疗是保护性因素。结论在老年男性冠心病人群中,降脂有益,但TC过低（TC〈4.16 mmol/L）增加全因死亡率;对于≥75岁冠心病人群,高TC血症不增加全因死亡率,提示对该人群可能无需强化降脂。

Objective To evaluate the relationship between serum total cholesterol（TC） and all cause mortality in the elderly male with coronary heart disease（CHD）. Methods In this retrospective cohort study,878 subjects aged 65 ~ 86 years with CHD were enrolled in 1996. Patients were divided into 4 groups according to their TC levels ：group1（TC 〈4.16mmol/L）,group2（4.16 ~4.68 mmol/L）,group3（4.68 ~ 5.2 mmol/L） and group4（TC ≥ 5.2 mmol/L）. The correlation between baseline Serum TC level and all cause death from 1996 to 2007 was analyzed with Cox multivariate proportional hazards regression. Results（1） The major death cause was CHD（31.30%）.（2） Compared with group1,the all cause death relative risk（RR） of groups 2、3 and 4 decreased respectively33%、19%、33%.（3） In population aged 75 and above,the all cause death RR of the group4 decreased 13% compared with that of the group1.（4） Cox multivariate proportional hazards regression analysis suggested that age 、smoking、drinking、fasting plasma glucose and history of hypertension were the risk factors of all cause death after the conventional risk factors of CHD were adjusted. Lipidlowering therapy was the protective factor. Conclusion Our results suggest that the TC level 〈4.16mmol/L may be a signal for increasing death risk. Lipid-lowering therapy is beneficial for the elderly,while intensive lipid-lowering therapy may not be needed for older（≥ 75） males with hypercholesterolemia.