中国老年人血脂异常患病率的Meta分析

Dyslipidemia Prevalence in Chinese Older Adults:a Meta-analysis

背景中国已步入老龄化社会且老年人口规模未来还将持续快速增长。血脂异常是老年人心脑血管疾病发生的重要危险因素。近年来,老年人血脂异常患病率明显上升,老年人血脂异常受到越来越多研究者的关注。由于受样本量、研究设计方案、调查地域、调查对象群体特征等因素的影响,中国老年人血脂异常患病状况研究结果不一。目的系统评价中国老年人血脂异常的患病率。方法计算机检索中国知网、中国生物医学文献数据库、维普中文科技期刊全文数据库、万方数据知识服务平台、PubMed、Web of Science、EmBase、The Cochrane Library,获取有关中国老年人血脂异常患病率的横断面研究,检索时限均为建库至2021年5月。由2位研究者独立筛选文献、提取资料并采用美国卫生保健质量和研究机构(AHRQ)推荐的横断面研究质量评价量表评价纳入研究的偏倚风险后,采用Stata 15.1软件进行Meta分析。结果共纳入19个横断面研究,样本总量101831,患病人数45785例。Meta分析结果显示,中国老年人血脂异常总体患病率为47.0%〔95%CI(40.0%,54.0%)〕,高胆固醇(TC)、高三酰甘油(TG)、高低密度脂蛋白胆固醇(LDL-C)、低高密度脂蛋白胆固醇(HDL-C)血症的患病率分别为19.7%〔95%CI(13.8%,25.5%)〕、20.8%〔95%CI(16.2%,25.4%)〕、15.3%〔95%CI(10.7%,19.8%)〕、20.2%〔95%CI(7.9%,32.4%)〕。亚组分析结果显示:男性高LDL-C血症患病率为17.2%,高于女性的9.0%(P<0.001);女性血脂异常总体患病率(48.8%)、高TC血症患病率(24.0%)、高TG血症患病率(23.4%)、低HDL-C血症患病率(20.4%)均高于男性(分别为39.5%、12.9%、19.0%、14.7%)(P<0.001)。年龄方面,老年人血脂异常总体患病率随年龄增长呈下降趋势(60~69岁为39.9%,70~79岁为31.8%,≥80岁为31.4%)(P<0.001);60~69岁老年人高TC血症患病率(12.9%)、高LDL-C血症患病率(10.0%)均高于70~79岁(分别为12.1%、9.4%)与≥80岁老年人(分别为9.5%、6.5%),70~79岁老年人高TG血症患病率(19.3%)、低HDL-C血症患病率(10.5%)均高于60~69岁(分别为16.4%、9.7%)与≥80岁老年人(分别为15.5%、9.5%),≥80岁老年人各类血脂异常患病率均低于60~69岁、70~79岁老年人(P<0.001)。西部地区老年人高TG血症患病率为20.0%,高于东部地区老年人的19.7%(P<0.001);东部地区老年人血脂异常总体患病率(49.3%)、高TC血症患病率(23.0%)、高LDL-C血症患病率(21.3%)、低HDL-C血症患病率(13.5%)均高于西部地区老年人(分别为36.8%、11.4%、7.8%、7.8%)(P<0.001)。结论中国老年人血脂异常患病率较高。不同性别、年龄段、地区老年人血脂异常总体患病率及各型血脂异常患病率存在差异。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Background China has stepped into an aging society,and its aging population is rapidly increasing.Recent years have seen a notable increased dyslipidemia prevalence in older adults,which has gained growing attentions as a major risk for cardiovascular and cerebrovascular diseases in this population.There is little consistency between studies on dyslipidemia prevalence in Chinese older adults due to differences of size and features of sample,design and setting.Objective To systematically evaluate the prevalence of dyslipidemia among Chinese older adults.Methods Cross-sectional studies relevant to the prevalence of dyslipidemia among Chinese elderly population were searched in databases including CNKI,CBM,CQVIP,WanFang,PubMed,Web of Science,Embase and the Cochrane Library from inception to May 2021.Two researchers performed literature screening and data extraction,separately.The Agency for Healthcare Research and Quality methodology checklist was used to assess the risk of bias.Stata 15.1 was adopted for meta-analysis.Results A total of 19 cross-sectional studies were included,involving 101931 cases,and 45785 of them had dyslipidemia.Meta-analysis results showed that the overall prevalence of dyslipidemia among the participants was 48.0%〔95%CI(41.0%,54.0%)〕.Specifically,the prevalence of elevated total cholesterol(TC),triglyceride(TG),and low-density lipoprotein cholesterol(LDL-C)as well as lowered low high-density lipoprotein cholesterol(HDL-C)was 19.7%〔95%CI(13.8%,25.5%)〕,20.8%〔95%CI(16.2%,25.4%)〕,15.3%〔95%CI(10.7%,19.8%)〕,and 20.2%〔95%CI(7.9%,32.4%)〕,respectively.Sex-specific analysis found that men had higher prevalence of elevated LDL-C than women(17.2%vs 9.0%).Women had higher overall prevalence of dyslipidemia than men(48.8%vs 39.5%).Moreover,women also had higher prevalence of elevated TC(24.0%vs 12.9%),and TG(23.4%vs 19.0%),as well as lowered HDL-C(20.4%vs 14.7%).Age-specific analysis revealed that dyslipidemia prevalence in age groups of 60-69,70-79,and≥80 years old was 39.9%,31.8%,and 31.4%,respectively,showing a trend of decrease with age.The prevalence of elevated TC in 60-69 year-olds(12.9%)was higher than that of 70-79 year-olds(12.1%)or 80 year-olds and above(9.5%).The prevalence of elevated LDL-C in 60-69 year-olds(10.0%)was higher than that of 70-79 year-olds(9.4%)or 80 year-olds and above(6.5%).The prevalence of elevated TG in 70-79 year-olds(19.3%)was higher than that of 60-69 year-olds(16.4%)or 80 year-olds and above(15.5%).The prevalence of lowered HDL-C in 70-79 year-olds(10.5%)was higher than that of 60-69 year-olds(9.7%)or 80 year-olds and above(9.5%).Those aged≥80 years had lower prevalence of various forms of dyslipidemia than 60-69 year-olds and 70-79 year-olds.Region-specific analysis indicated that compared to those from western China,participants from eastern China had higher overall prevalence of dyslipidemia(49.3%vs 36.8%).Moreover,they also showed higher prevalence of elevated TC(23.0%vs 11.4%),elevated LDL-C(21.3%vs 7.8%)and lowered HDL-C(13.5%vs 7.8%).However,they had slightly lower prevalence of elevated TG(19.7%vs 20.0%).Conclusion The overall prevalence of dyslipidemia was high in Chinese older adults.Sex-,age group-and region-specific differences were found in the overall prevalence of dyslipidemia,and prevalence of various forms of dyslipidemia.Due to limited number and non-ideal quality of the included studies,the above conclusions need to be verified by more high-quality studies.