老年人血脂与冠心病的长期随访研究  

A long-term follow-up study of serum lipids and coronary heart disease in the elderly

作　　者：李健斋[1] 陈曼丽[1] 王抒[1] 董军[1] 曾平[1] 侯鲁维[1] 

机构地区：[1]卫生部北京医院老年医学研究所,北京100730

出　　处：《中华心血管病杂志》2002年第11期647-650,共4页Chinese Journal of Cardiology

摘　　要：目的　前瞻性观察老年人高血脂是否仍是增加冠心病 (CHD)危险的因素 ,高龄 (80岁以上 )老人是否需要调脂治疗。方法　对 12 11例年龄 (70± 9)岁的离休干部 (男性占 92 %)在 1986年～2 0 0 0年间作长期随访 ,平均随访 11 2年。观察血脂水平与急性心肌梗死 (AMI)发生及CHD死亡的关系。结果　 (1)本组老年人血脂异常者达 2 / 3,胆固醇偏高的占 5 1 6 %。(2 )累计死亡 397例 ,高血脂组的总死亡率 (31 6 %)略低于血脂正常组 (35 3%) ,P =0 1931。CHD总计 (大多数为非致死性AMI)2 14例 ,占总人数的 17 7%。其中高血脂组 (2 0 9%)多于血脂正常组 (11 4 %) ,P =0 0 0 0 1。CHD死亡89例中也是高脂血症组 (8 9%)高于血脂正常组 (4 4 %) ,P =0 0 0 45。(3)Logistic回归选入年龄、高血压、低密度与高密度脂蛋白胆固醇等 4项是CHD的主要危险因素。结论　本组老年人血脂较高 ,高胆固醇多见 ,AMI发生率也较高 ,提示高胆固醇仍是增加老年人 (甚至 80岁以上老人 )AMI及CHD死亡危险的因素 ,对健康状况较好的高龄老人除调整生活方式外也应作适当的调脂治疗。Objective To study prospectively whether hyperlipidemia remains to be correlated with increasing risk of coronary heart disease (CHD) in the aged, and whether it is appropriate to use lipid lowering drugs in the elderly (≥ 80 years old) according to the recommended guidelines for lipid management. Methods 1 211 retirees, mainly males (92%),initial age (70±9) years old, were enrolled in the study. Health behavior and medical history were taken by questionnaires. All cases participated in annual physical examination with blood chemistry survey during the year 1986-2000. Mean follow-up period was 11.2 years. Serum lipid parameters including total cholesterol (TC), low and high-density lipoprotein cholesterol (LDL-C and HDL-C) and triglycerides (TG) were analyzed according to the requirements of lipid standardization. The association between lipid levels and prevalence of acute myocardial infarction (AMI) or coronary death was analyzed statistically. Results (1) Lipid abnormalities occurred in 2/3 of the aged subjects. The most common lipid disorder was high TC (and high LDL-C), which was much more prevalent than high TG. 51.6% of the cases had a TC level above 5.2mmol/L, with no significant decrease until age above 90. (2) Cumulative total death due to various diseases was 397 cases in 15 years, with slightly lower mortality rate in the high lipid group than that in the normal lipid group (30.6% vs. 35.3%), but there is no significant difference (P= 0.193 1). However the coronary death rate was higher in the high lipid group than that in the normal lipid group (7.9% vs 4.6%, P= 0.004?5). Among the total 214 CHD cases (mostly non-fatal AMI), the incidence was higher in the high lipid group than that in the normal lipid group (20.9% vs 11.4%, P= 0.000?1). (3) Logistic regression analysis revealed that age, hypertension, LDL-C and HDL-C were main risk factors of CHD. Conclusion The above results showed that high TC (LDL-C) level is still concerned with increasing CHD risk even in the elderly above age 8

关 键 词：冠心病 老年人 血脂 心肌梗塞 随访 危险因素 

分 类 号：R541.4[医药卫生—心血管疾病]