Lifetime risks of cardiovascular disease.
Lifetime risks of cardiovascular disease.
复制标题
DOI：
10.1056/nejmoa1012848
复制
发表时间：
2012-01-26
期刊：
影响因子：
--
通讯作者：
Lloyd-Jones DM
中科院分区：
文献类型：
--
作者：
Berry JD;Dyer A;Cai X;Garside DB;Ning H;Thomas A;Greenland P;Van Horn L;Tracy RP;Lloyd-Jones DM
在黑人成年人和白人成年人中，心血管疾病的终生风险还没有跨年龄段的报告。我们在个体水平上进行了荟萃分析，使用了18项队列研究的数据，这些研究总共涉及257,384名黑人男性和女性以及白人男性和女性，他们的心血管疾病风险因素是在45岁、55岁、65岁和75岁时测量的。血压、胆固醇水平、吸烟状况和糖尿病状况被用来根据危险因素将参与者分成五个相互排斥的类别。每一类别的参与者在每个年龄段都估计了心血管事件的剩余终身风险，没有心血管疾病的死亡被视为竞争事件。我们观察到不同危险因素阶层患心血管疾病的终生风险有显著差异。在55岁的参与者中，那些具有最佳风险因素(总胆固醇水平为180毫克/升[4.7 mmol/升]；血压为120毫米汞柱收缩压和80毫米汞柱舒张压；非吸烟状态；以及非糖尿病状态)的人在80岁之前死于心血管疾病的风险大大低于有两个或两个以上主要风险因素的参与者(男性为4.7%，女性为6.4%，女性为20.5%)。具有最佳风险因素的患者一生中罹患致命冠心病或非致命心肌梗死的风险也较低(男性为3.6%比37.5%，女性为1%比18.3%)，致命或非致命中风的风险也较低(男性为2.3%比8.3%，女性为5.3%比10.7%)。在黑人和白人以及不同的出生队列中，风险因素阶层中也观察到了类似的趋势。风险因素负担的差异转化为心血管疾病终生风险的显著差异，这些差异在种族和出生队列中是一致的。(由国家心肺血液研究所资助。)
The lifetime risks of cardiovascular disease have not been reported across the age spectrum in black adults and white adults. We conducted a meta-analysis at the individual level using data from 18 cohort studies involving a total of 257,384 black men and women and white men and women whose risk factors for cardiovascular disease were measured at the ages of 45, 55, 65, and 75 years. Blood pressure, cholesterol level, smoking status, and diabetes status were used to stratify participants according to risk factors into five mutually exclusive categories. The remaining lifetime risks of cardiovascular events were estimated for participants in each category at each age, with death free of cardiovascular disease treated as a competing event. We observed marked differences in the lifetime risks of cardiovascular disease across risk-factor strata. Among participants who were 55 years of age, those with an optimal risk-factor profile (total cholesterol level, <180 mg per deciliter [4.7 mmol per liter]; blood pressure, <120 mm Hg systolic and 80 mm Hg diastolic; nonsmoking status; and nondiabetic status) had substantially lower risks of death from cardiovascular disease through the age of 80 years than participants with two or more major risk factors (4.7% vs. 29.6% among men, 6.4% vs. 20.5% among women). Those with an optimal risk-factor profile also had lower lifetime risks of fatal coronary heart disease or nonfatal myocardial infarction (3.6% vs. 37.5% among men, <1% vs. 18.3% among women) and fatal or nonfatal stroke (2.3% vs. 8.3% among men, 5.3% vs. 10.7% among women). Similar trends within risk-factor strata were observed among blacks and whites and across diverse birth cohorts. Differences in risk-factor burden translate into marked differences in the lifetime risk of cardiovascular disease, and these differences are consistent across race and birth cohorts. (Funded by the National Heart, Lung, and Blood Institute.)