고콜레스테롤혈증 환자에서 생활습관 중재 시 LDL-콜레스테롤 변화와 관련된 요인
Determinants of Responsiveness of LDL-cholesterol Lowering to Lifestyle Modifi cation in Hypercholesterolemic Patients
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연구 배경: 고지혈증 환자에서 생활습관 중재는 일차적 치료 선택 방법이나 이에 대한 반응은 개개인마다 상당한 차이가 있다. 따라서 본 연구에서는 외래 환자에서 단기간 생활습관 중재 시 지질 대사 개선 정도에 영향을 미치는 임상적, 생물학 적 지표를 알아보고자 하였다. 방법: 2007년 6월부터 2008년 3월까지 서울 소재 3차병원 가 정의학과를 방문한 30세 이상의 고지혈증 환자 161명(남자 =52명, 여자=109명)을 대상으로 식사 습관을 포함한 포괄 적 생활습관 교정에 대해 약 20분간의 표준화 평가와 교육을 시행하고 8주 후 추적 관찰하였다. 첫 방문과 8주 후, 신체계 측, 생활습관 인자, 혈중지질 농도를 조사하여 이를 바탕으로 LDL-콜레스테롤의 변화량과 이에 영향을 주는 독립적 요인 을 분석하였다. 결과: 중재 후 총콜레스테롤과 LDL-콜레스테롤은 여자에서 는 7.6%와 8.0%, 남자에서는 5.9%와 5.0%의 감소를 보였고 이 는 모두 통계적으로 유의하였다(P<0.001). 생활습관 중재에 대한 LDL콜레스테롤의 변화량을 예측하기 위해 다중선형 회귀분석을 한 결과, 여자에서는 식습관 순응도가 높을수록 (β=0.267), 운동량 변화가 많을수록(β=0.196) LDL-C 감소 반 응이 더 좋은 것으로, 폐경이 된 여성에서(β=-0.207) LDL-C 감소 반응이 덜 나타나고 남자의 경우는 식습관 순응도가 높 을수록(β=0.372) LDL-C 감소 반응이 더 좋은 것으로 나타났 다. 결론: 지질대사 개선을 위한 생활습관 중재의 반응성 예측에 는 식습관 변화, 운동량 증가가 중요한 요인으로 작용하며, 여 자에서는 폐경이 독립적인 예측요인으로 작용하므로 이에 대 한 고려가 필요하다.
Abstract
Background: Current guidelines for the treatment of hyperlipidemia propose lifestyle modification as a first-line intervention. The aim of this study was to identify the factors which determine responsiveness of LDL-cholesterol lowering to lifestyle modifi cation in hypercholesterolemic patients. Methods: A total of 109 patients aged between 30 and 70 years (52 men and 109 women) who were diagnosed with hypercholesterolemia between July 2007 and February 2008 at Asan Medical Center were enrolled in this study. The patients were educated on lifestyle modifi cations by trained family physicians. We measured clinical, anthropometric, lifestyle parameters and lipid profiles initially and at eight weeks after education. Stepwise multiple linear regression models were used to assess covariates and variance components. Results: The serum level of LDL-cholesterol decreased in both women (8.0 ± 15.37%, P < 0 .001) and men (4.95 ± 9.81%, P < 0.001). In women, dietary adherence (β = 0.267, P = 0.004), change in physical activity duration (β = 0.196, P = 0.034) and menopausal state (β = -0.207, P = 0.026) were signifi cant predictors in response of percent change in LDL- cholesterol. In men, dietary adherence (β = 0.372, P = 0.007) was a predictor in response of percent change in LDL-cholesterol. Conclusion: Adherence to lifestyle modifi cation was a main factor which had infl uenced on response of percent change in LDL-C levels. In women, however, menopausal state was also an important factor.
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