1、百岁园公司健康科普知识讲座Gotto AM Jr, et al. Gotto AM Jr, et al. Circulation.Circulation. 1990;81:1721-1733. 1990;81:1721-1733.Castelli WP. Castelli WP. Am J Med.Am J Med. 1984;76:4-12. 1984;76:4-12.1010年冠心病死亡率年冠心病死亡率 ( (死亡数死亡数/1000)/1000)血清胆固醇血清胆固醇 ( (mg/dl)mg/dl) 总胆固醇水平减少总胆固醇水平减少1% 1% 冠心病危险性减少冠心病危险性减少2%2%每每10
2、001000人中冠心病发病数人中冠心病发病数血清胆固醇血清胆固醇 ( (mg/dl)mg/dl)20204 4205-205-234234235-264235-264265-265-29429429295 51501502002002502503003000 050504040303020201010 总胆固醇水平升高总胆固醇水平升高1% 1% 冠心病危险性增加冠心病危险性增加2%2%43210150200250300Plasma Cholesterol (mg/dL)CHD Risk RatioPooling ProjectFramingham Heart StudyIsraeli Pros
3、pective StudyData from the Shanghai study, conducted in 9021 Chinese people with 813 years follow up.Numbers of deaths from CHD in each baseline cholesterol group are shown with vertical lines that represent one standard deviation. Chen Z et al. BMJ 1991;303:276282.冠心病死亡相对危险性冠心病死亡相对危险性平均平均 TC mmol/L
4、 (mg/dL)TC mmol/L (mg/dL)0.250.250.500.501.001.002.002.003.63.6(139)(139)9 94 4121218183.83.8(147)(147)4.24.2(162)(162)4.44.4(170)(170)4.04.0(155)(155)4.64.6(178)(178)4.84.8(186)(186) 3.53 (136)3.53 (136)3.544.10 (137158)3.544.10 (137158)4.114.62 (159178)4.114.62 (159178)4.63 (179)4.63 (179)基线基线 TC
5、TC mmol/L (mg/dL) mmol/L (mg/dL)冠心病等危症冠心病等危症Haffner SM et al. Haffner SM et al. N Engl J MedN Engl J Med 1998;339:229-234. 1998;339:229-234.致命与非致命性致命与非致命性MI MI (%)(%) Prior MIPrior MI18.818.83.53.545.045.020.220.2P0.001P0.001P0.001P0.001Prior MIPrior MINo prior MINo prior MINo prior No prior MIMI无糖尿
6、病无糖尿病糖尿病糖尿病( (n=1373)n=1373)( (n=1059)n=1059)芬兰人群芬兰人群7 7年随访期年随访期MIMI发生情况发生情况冠心病和冠心病等危症冠心病和冠心病等危症采取一致性的降胆固醇策略采取一致性的降胆固醇策略JAMA 2001;285:2486-2497一级预防一级预防二级预防二级预防危险性分层危险性分层 LDLLDL目标值目标值开始开始TLCTLC治疗治疗LDL-CLDL-C水平水平开始药物治疗开始药物治疗LDL-CLDL-C水平水平癌症患者胆固醇水平低摄入减少消耗增加神经元细胞可自身合成所需的胆固醇Iso H, et al. N Engl J Med. 1989;320:904-910. 病人主诉，如肌肉酸痛等， 注意检测肝功能、CK。
