期刊
HEART
卷 97, 期 11, 页码 923-930出版社
BMJ PUBLISHING GROUP
DOI: 10.1136/hrt.2010.216309
关键词
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资金
- Medical Research Council, UK
- Economic and Social Research Council, UK
- British Heart Foundation, UK
- Health and Safety Executive, UK
- Department of Health, UK
- BUPA Foundation, UK
- National Heart Lung and Blood Institute [R01HL036310]
- USA
- NIH: National Institute on Aging [R01AG013196, R01AG034454]
- British Heart Foundation
- Academy of Finland, Finland
- EU
- British Heart Foundation [RG/07/008/23674] Funding Source: researchfish
- Medical Research Council [G19/35, G0100222, G8802774, G0902037] Funding Source: researchfish
- MRC [G0902037] Funding Source: UKRI
Objective To examine the association of lipid-lowering drugs, change in diet and physical activity with a decline in low-density lipoprotein (LDL) cholesterol in middle age. Design A prospective cohort study. Setting The Whitehall II study. Participants 4469 British civil servants (72% men) aged 39-62 years at baseline. Main Outcome Measure Change in LDL-cholesterol concentrations between the baseline (1991-3) and follow-up (2003-4). Results Mean LDL-cholesterol decreased from 4.38 to 3.52 mmol/l over a mean follow-up of 11.3 years. In a mutually adjusted model, a decline in LDL-cholesterol was greater among those who were taking lipid-lowering treatment at baseline (-1.14 mmol/l, n=34), or started treatment during the follow-up (-1.77 mmol/l, n=481) compared with untreated individuals (n=3954; p < 0.001); among those who improved their diet-especially the ratio of white to red meat consumption and the ratio of polyunsaturated to saturated fatty acids intake-(-0.07 mmol/l, n=717) compared with those with no change in diet (n=3071; p=0.03) and among those who increased physical activity (-0.10 mmol/l, n=601) compared with those with no change in physical activity (n=3312; p=0.005). Based on these estimates, successful implementation of lipid-lowering drug treatment for high-risk participants (n=858) and favourable changes in diet (n=3457) and physical activity (n=2190) among those with non-optimal lifestyles would reduce LDL-cholesterol by 0.90 to 1.07 mmol/l in the total cohort. Conclusions Both lipid-lowering pharmacotherapy and favourable changes in lifestyle independently reduced LDL-cholesterol levels in a cohort of middle-aged men and women, supporting the use of multifaceted intervention strategies for prevention.
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