丹麦哥本哈根大学医院Børge Grønne Nordestgaard团队研究了丹麦居民低密度脂蛋白胆固醇与全因死亡风险的相关性。2020年12月8日，该研究发表在《英国医学杂志》上。

为了确定低密度脂蛋白胆固醇（LDL-C）水平与全因死亡率之间的相关性，以及LDL-C水平与一般人群全因死亡最低风险之间的关系，研究组在丹麦进行了一项前瞻性队列研究，2003-2015年招募参与者，平均随访9.4年，主要结局为全因死亡率，次要结局为特定原因死亡率。

在108243名20-100岁的参与者中，有11376名（10.5％）在研究期间死亡，死亡中位年龄为81岁。LDL-C水平与全因死亡风险之间呈U型关联，过低或过高均会增加全因死亡的风险。与LDL-C水平为3.4-3.9 mmol/L（132-154 mg/dL）的参与者相比，当LDL-C水平小于1.8 mmol/L（<70 mg/dL）时，全因死亡的多变量校正风险比为1.25；当LDL-C水平超过4.8 mmol/L（>189 mg/dL） 时，风险比为1.15。

在总体人群和未接受降脂治疗的参与者中，LDL-C的水平为3.6 mmol/L（140 mg/dL） 时，全因死亡的风险最低，而在接受降脂治疗的个体中，LDL-C水平为2.3 mmol/L（89 mg/dL）时全因死亡风险最低。在各个年龄段的男性和女性中，除心血管死亡率外，对于癌症和其他原因死亡率均观察到相似结果。LDL-C水平的任何升高都与心肌梗死风险增加有关。

研究结果表明，在一般人群中，LDL-C水平过高或过低均会增加全因死亡的风险，且LDL-C水平为3.6 mmol/L时，全因死亡风险最低。

附：英文原文

Title: Association between low density lipoprotein and all cause and cause specific mortality in Denmark: prospective cohort study

Author: Camilla Ditlev Lindhardt Johannesen, Anne Langsted, Martin Bdtker Mortensen, Brge Grnne Nordestgaard

Issue&Volume: 2020/12/08

Abstract:

Objective To determine the association between levels of low density lipoprotein cholesterol (LDL-C) and all cause mortality, and the concentration of LDL-C associated with the lowest risk of all cause mortality in the general population.

Design Prospective cohort study.

Setting Denmark; the Copenhagen General Population Study recruited in 2003-15 with a median follow-up of 9.4 years.

Participants Individuals randomly selected from the national Danish Civil Registration System.

Main outcome measures Baseline levels of LDL-C associated with risk of mortality were evaluated on a continuous scale (restricted cubic splines) and by a priori defined centile categories with Cox proportional hazards regression models. Main outcome was all cause mortality. Secondary outcomes were cause specific mortality (cardiovascular, cancer, and other mortality).

Results Among 108243 individuals aged 20-100, 11376 (10.5%) died during the study, at a median age of 81. The association between levels of LDL-C and the risk of all cause mortality was U shaped, with low and high levels associated with an increased risk of all cause mortality. Compared with individuals with concentrations of LDL-C of 3.4-3.9 mmol/L (132-154 mg/dL; 61st-80th centiles), the multivariable adjusted hazard ratio for all cause mortality was 1.25 (95% confidence interval 1.15 to 1.36) for individuals with LDL-C concentrations of less than 1.8 mmol/L (<70 mg/dL; 1st-5th centiles) and 1.15 (1.05 to 1.27) for LDL-C concentrations of more than 4.8 mmol/L (>189 mg/dL; 96th-100th centiles). The concentration of LDL-C associated with the lowest risk of all cause mortality was 3.6 mmol/L (140 mg/dL) in the overall population and in individuals not receiving lipid lowering treatment, compared with 2.3 mmol/L (89 mg/dL) in individuals receiving lipid lowering treatment. Similar results were seen in men and women, across age groups, and for cancer and other mortality, but not for cardiovascular mortality. Any increase in LDL-C levels was associated with an increased risk of myocardial infarction.

Conclusions In the general population, low and high levels of LDL-C were associated with an increased risk of all cause mortality, and the lowest risk of all cause mortality was found at an LDL-C concentration of 3.6 mmol/L (140 mg/dL).

DOI: 10.1136/bmj.m4266

Source: https://www.bmj.com/content/371/bmj.m4266