我国队列人群1998～2015年血清总胆固醇水平的变化趋势
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摘要
目的:探讨我国队列人群1998~2015年血清总胆固醇(TC)水平的变化趋势。方法:研究对象来自中国心血管病流行病学多中心协作研究(ChinaMUCA)和心血管健康多中心合作研究(InterASIA)的队列人群。两项研究的队列人群以1998~2001年心血管病危险因素调查为基线,此后在2007~2008年和2013~2015年又进行了两次随访。本次分析纳入了三次调查中血清TC信息完整的35~74岁的9 477例研究对象。采用重复测量设计资料方差分析法比较不同人群血清TC的变化,人群血清TC水平采用均数(标准误)表示。结果:本研究队列人群三次调查的血清TC水平呈升高趋势:基线水平为4.81(0.01)mmol/L,后两次调查分别为4.91(0.01)mmol/L和4.98(0.01)mmol/L,增长率依次为2.08%和3.53%(P_(trend)<0.001)。女性人群血清TC水平上升,且35~45岁青年女性增长幅度最大(11.43%),男性人群血清TC水平变化不显著。城市人群血清TC水平始终高于农村人群且增速更快。结论:1998~2015年我国队列人群血清TC水平增高,其中青年女性和城市人群增幅较大,是心血管病防治的重点关注人群。
Objectives: To explore the trends of serum total cholesterol(TC) among Chinese adult cohorts from 1998 to 2015. Methods: The subjects of this study came from China Multicenter Collaborative Study of Cardiovascular Epidemiology and International Collaborative Study of Cardiovascular Disease in Asia. The baseline investigations were completed during 1998-2001, and the two follow-ups were conducted during 2007-2008 and 2013-2015, respectively. A total of 9 477 participants aged 35-74 years with complete serum TC data from three surveys were included in this study. Analysis on variance of data regarding repeated measurements were used to investigate the variation of serum TC in different subgroups. The serum TC levels were represented by mean(standard errors). Results: During 1998-2015, the mean level of serum TC of all participants significantly elevated from 4.81(0.01) mmol/L to 4.91(0.01) mmol/L, and to 4.98(0.01) mmol/L, growth rates of which were 2.08% and 3.53% in the first and second follow-up, respectively(Ptrend <0.001), especially for females. The fastest growth was noted in the group of young women aged 35-45 years over time, with a growth rate of 11.43%. No such a significant change in the male group during follow-up. The serum TC level and itsgrowth rate in urban residents was significantly higher than those in rural residents. Conclusions: Longitudinal data demonstrated that the mean serum TC level among Chinese adults was continuously increased during 1998~2015. Prevention strategy for hypercholesterolemia should focus more on young women and urban residents.
Objectives: To explore the trends of serum total cholesterol(TC) among Chinese adult cohorts from 1998 to 2015. Methods: The subjects of this study came from China Multicenter Collaborative Study of Cardiovascular Epidemiology and International Collaborative Study of Cardiovascular Disease in Asia. The baseline investigations were completed during 1998-2001, and the two follow-ups were conducted during 2007-2008 and 2013-2015, respectively. A total of 9 477 participants aged 35-74 years with complete serum TC data from three surveys were included in this study. Analysis on variance of data regarding repeated measurements were used to investigate the variation of serum TC in different subgroups. The serum TC levels were represented by mean(standard errors). Results: During 1998-2015, the mean level of serum TC of all participants significantly elevated from 4.81(0.01) mmol/L to 4.91(0.01) mmol/L, and to 4.98(0.01) mmol/L, growth rates of which were 2.08% and 3.53% in the first and second follow-up, respectively(Ptrend <0.001), especially for females. The fastest growth was noted in the group of young women aged 35-45 years over time, with a growth rate of 11.43%. No such a significant change in the male group during follow-up. The serum TC level and itsgrowth rate in urban residents was significantly higher than those in rural residents. Conclusions: Longitudinal data demonstrated that the mean serum TC level among Chinese adults was continuously increased during 1998~2015. Prevention strategy for hypercholesterolemia should focus more on young women and urban residents.
引文
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[17]姜红如,王志宏,欧阳一非,等.1991~2011年中国9省区成年人膳食胆固醇摄入的分布变化及影响因素[J].营养学报,2016,38(3):222-228.DOI:10.13325/j.cnki.acta.nutr.sin.2016.03.004.
[18]陈海燕,李莹,麦劲壮,等.中年人群体育锻炼与血脂水平关系的横断面研究[J].中国循环杂志,2016,31(7):659-663.DOI:10.3969/j.issn.1000-3614.2017.07.009.
[19]Gong P,Liang S,Carlton EJ,et al.Urbanisation and health in China[J].Lancet,2012,379(9818):843-852.DOI:10.1016/S0140-6736(11)61878-3.
[20]郝光,王增武,张林峰,等.我国农村地区高胆固醇血症患病情况分析[J].心脑血管病防治,2014,14(5):389-393.DOI:10.3969/j.issn.1009-816x.2014.05.12.
[21]Ford ES,Li CY,Pearson WS,et al.Trends in hypercholesterolemia,treatment and control among United States adults[J].Int J Cardiol,2010,140(2):226-235.DOI:10.1016/j.ijcard.2008.11.033.
[22]Zhai Y,Fang HY,Yu WT,et al.Changes in waist circumference and abdominal obesity among chinese adults over a ten-year period[J].Biomed Environ Sci,2017,30(5):315-322.DOI:10.3967/bes2017.042.
[23]Farzadfar F,Finucane MM,Danaei G,et al.National,regional,and global trends in serum total cholesterol since 1980:systematic analysis of health examination surveys and epidemiological studies with 321 country-years and 3.0 million participants[J].Lancet,2011,377(9765):578-586.DOI:10.1016/S0140-6736(10)62038-7.
[24]Piepoli MF,Hoes AW,Brotons C,et al.Main messages for primary care from the 2016 European guidelines on cardiovascular disease prevention in clinical practice[J].Eur J Gen Pract,2018,24(1):51-56.DOI:10.1080/13814788.2017.1398320.
[2]Shapiro MD,Fazio S.From lipids to inflammation:new approaches to reducing atherosclerotic risk[J].Circ Res,2016,118(4):732-749.DOI:10.1161/CIRCRESAHA.115.306471.
[3]Lloyd-Jones DM,Morris PB,Ballantyne CM.et al.2017 Focused update of the 2016 ACC expert consensus decision pathway on the role of non-statin therapies for LDL-cholesterol lowering in the management of atherosclerotic cardiovascular disease risk:a report of the American College of Cardiology task force on expert consensus decision pathways[J].J Am Coll Cardiol,2017,70(14):1785-1822.DOI:10.1016/j.jacc.2017.07.745.
[4]Song PK,Li H,Man QQ,et al.Trends in determinants of hypercholesterolemia among Chinese adults between 2002 and 2012:results from the National Nutrition Survey[J].Nutrients,2017,9:279.DOI:10.3390/nu9030279.
[5]GBD 2015 Risk Factors Collaborators.Global,regional,and national comparative risk assessment of 79 behavioural,environmental and occupational,and metabolic risks or clusters of risks,1990-2015:a systematic analysis for the Global Burden of Disease Study 2015[J].Lancet,2016,388(10053):1659-1724.DOI:10.1016/S0140-6736(16)31679-8.
[6]杨静,王卓群,赵艳芳,等.2013年中国归因于高血清总胆固醇的疾病负担研究[J].中华预防医学杂志,2016,50(9):764-768.DOI:10.3760/cma.j.issn.0253-9624.2016.09.004.
[7]He J,Gu D,Reynolds K,et al.Serum total and lipoprotein cholesterol levels and awareness,treatment,and control of hypercholesterolemia in China[J].Circulation,2004,110(4):405-411.DOI:10.1161/01.CIR.0000136583.52681.0D.
[8]Yang W,Xiao J,Yang Z,et al.Serum lipids and lipoproteins in Chinese men and women[J].Circulation,2012,125(18):2212-2221.DOI:10.1161/CIRCULATIONAHA.111.065904.
[9]张坚,满青青,王春荣,等.中国18岁及以上人群血脂水平及分布特征[J].中华预防医学杂志,2005,39(5):302-305.DOI:10.3760/j:issn:0253-9624.2005.05.003.
[10]李剑虹,米生权,李镒冲,等.2010年我国成年人血脂水平及分布特征[J].中华预防医学杂志,2012,46(7):607-612.DOI:10.3760/cma.j.issn.0253-9624.2012.07.007.
[11]王薇,刘静,王淼,等.1992至2007年多省市队列人群血清总胆固醇水平的变化特点[J].中华心血管病杂志,2014,42(3):230-235.DOI:10.3760/cma.j.issn.0253-3758.2014.03.011.
[12]Zhang LF,Yang J,Hong Z,et al.Proportion of different subtypes of stroke in China[J].Stroke,2003,34(9):2091-2096.DOI:10.1161/01.STR.0000087149.42294.8C.
[13]Yang X,Li J,Hu D,et al.Predicting the 10-year risks of atherosclerotic cardiovascular disease in chinese population:the China-PAR Project(Prediction for ASCVD Risk in China)[J].Circulation,2016,134(19):1430-1440.DOI:10.1161/CIRCULATIONAHA.116.022367.
[14]Kolovou GD,Bilianou HG.Influence of aging and menopause on lipids and lipoproteins in women[J].Angiology,2008,59(2 Suppl):54s-57s.DOI:10.1177/0003319708319645.
[15]中国医师协会心血管内科医师分会女医师工作委员会,中华医学会心血管病学分会女性心脏健康学组.绝经后女性血脂异常管理的中国专家共识[J].中国循环杂志,2014,29(Suppl2):120-123.DOI:10.3969/j.issn.1000-3614.2014.增刊.027.
[16]Pan L,Yang Z,Wu Y,et al.The prevalence,awareness,treatment and control of dyslipidemia among adults in China[J].Atherosclerosis,2016,248:2-9.DOI:10.1016/j.atherosclerosis.2016.02.006.
[17]姜红如,王志宏,欧阳一非,等.1991~2011年中国9省区成年人膳食胆固醇摄入的分布变化及影响因素[J].营养学报,2016,38(3):222-228.DOI:10.13325/j.cnki.acta.nutr.sin.2016.03.004.
[18]陈海燕,李莹,麦劲壮,等.中年人群体育锻炼与血脂水平关系的横断面研究[J].中国循环杂志,2016,31(7):659-663.DOI:10.3969/j.issn.1000-3614.2017.07.009.
[19]Gong P,Liang S,Carlton EJ,et al.Urbanisation and health in China[J].Lancet,2012,379(9818):843-852.DOI:10.1016/S0140-6736(11)61878-3.
[20]郝光,王增武,张林峰,等.我国农村地区高胆固醇血症患病情况分析[J].心脑血管病防治,2014,14(5):389-393.DOI:10.3969/j.issn.1009-816x.2014.05.12.
[21]Ford ES,Li CY,Pearson WS,et al.Trends in hypercholesterolemia,treatment and control among United States adults[J].Int J Cardiol,2010,140(2):226-235.DOI:10.1016/j.ijcard.2008.11.033.
[22]Zhai Y,Fang HY,Yu WT,et al.Changes in waist circumference and abdominal obesity among chinese adults over a ten-year period[J].Biomed Environ Sci,2017,30(5):315-322.DOI:10.3967/bes2017.042.
[23]Farzadfar F,Finucane MM,Danaei G,et al.National,regional,and global trends in serum total cholesterol since 1980:systematic analysis of health examination surveys and epidemiological studies with 321 country-years and 3.0 million participants[J].Lancet,2011,377(9765):578-586.DOI:10.1016/S0140-6736(10)62038-7.
[24]Piepoli MF,Hoes AW,Brotons C,et al.Main messages for primary care from the 2016 European guidelines on cardiovascular disease prevention in clinical practice[J].Eur J Gen Pract,2018,24(1):51-56.DOI:10.1080/13814788.2017.1398320.