The population burden of heart failure attributable to modifiable risk factors: the ARIC (Atherosclerosis Risk in Communities) study.
The population burden of heart failure attributable to modifiable risk factors: the ARIC (Atherosclerosis Risk in Communities) study.
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DOI：
10.1016/j.jacc.2012.07.022
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发表时间：
2012-10-23
影响因子：
24
通讯作者：
Heiss, Gerardo
中科院分区：
文献类型：
--
作者：
Avery, Christy L.;Loehr, Laura R.;Baggett, Christopher;Chang, Patricia P.;Kucharska-Newton, Anna M.;Matsushita, Kunihiro;Rosamond, Wayne D.;Heiss, Gerardo
评估心力衰竭的人群负担以及可改变的风险因素的影响
心力衰竭是一种常见、代价高昂且致命的疾病，但很少有研究评估可改变的风险因素在人群层面的影响。
我们从社区动脉粥样硬化风险研究的14709名参与者中，评估了五种可改变的风险因素（吸烟、糖尿病、低密度脂蛋白升高、高血压和肥胖）与心力衰竭之间关联的发病率差异（IRD）。采用潜在影响分数来衡量在假设每种风险因素的患病率按比例降低5%的情况下心力衰竭发病率的预期变化。
在平均17.6年的随访中，三分之一的非裔美国参与者和四分之一的白人参与者因心力衰竭住院，心力衰竭定义为首次因国际疾病分类第九版（ICD - 9）出院编码为428.x而住院。在这五种可改变的风险因素中，糖尿病的IRD最大，在非裔美国参与者和白人参与者中，糖尿病分别与每10万人 - 年1058例（95%置信区间：787 - 1329）和660例（95%置信区间：514 - 805）心力衰竭住院事件相关。糖尿病患病率按比例降低5%，将分别使非裔美国和白人社区动脉粥样硬化风险研究（ARIC）参与者中每10万人 - 年心力衰竭住院事件减少约53例和33例。当应用于美国人群时，这种降低可能每年预防约30000例心力衰竭新发病例。
可改变的心力衰竭风险因素（如糖尿病）患病率的适度降低可能会大幅降低这种主要疾病的发病率。
To estimate the population burden of heart failure and the influence of modifiable risk factors. Heart failure is a common, costly, and fatal disorder, yet few studies have evaluated the population-level influence of modifiable risk factors. From 14,709 Atherosclerosis Risk in Communities study participants we estimated incidence rate differences (IRD) for the association between five modifiable risk factors (cigarette smoking, diabetes, elevated low density lipoproteins, hypertension, and obesity) and heart failure. Potential impact fractions were used to measure expected changes in the heart failure incidence assuming achievement of a 5% proportional decrement in the prevalence of each risk factor. Over an average of 17.6 years of follow-up, 1 in 3 African American and 1 in 4 Caucasian participants were hospitalized with heart failure, defined as the first hospitalization with ICD-9 discharge codes of 428.x. Of the five modifiable risk factors, the largest IRD was observed for diabetes, which was associated with 1,058 (95% CI: 787–1,329) and 660 (95% CI: 514–805) incident hospitalizations of heart failure/100,000 person-years among African American and Caucasian participants, respectively. A 5% proportional reduction in the prevalence of diabetes would result in approximately 53 and 33 fewer incident heart failure hospitalizations per 100,000 person-years in African American and Caucasian ARIC participants, respectively. When applied to U.S. populations, this reduction may prevent approximately 30,000 incident cases of heart failure annually. Modest decrements in the prevalence of modifiable heart failure risk factors such as diabetes may substantially decrease the incidence of this major disease.
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