Trends in the incidence of coronary heart disease and changes in diet and lifestyle in women
Trends in the incidence of coronary heart disease and changes in diet and lifestyle in women
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DOI：
10.1056/nejm200008243430802
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发表时间：
2000-08-24
影响因子：
158.5
通讯作者：
Willett, WC
中科院分区：
文献类型：
--
作者：
Hu, FB;Stampfer, MJ;Willett, WC
背景：先前的研究发现血压、血清胆固醇水平以及冠心病的发病率和死亡率同时下降。然而，饮食和生活方式的变化对冠心病趋势的影响在很大程度上尚不清楚。 方法：我们在护士健康研究中跟踪了 1980 年至 1994 年期间 85,941 名 34 至 59 岁、之前未诊断出心血管疾病或癌症的女性。饮食和生活方式变量在基线时进行评估，并在随访期间进行更新。结果：在调整年龄影响后，冠心病的发病率从 1980-1982 年两年期到 1992-1994 年两年期下降了 31%。从 1980 年到 1992 年，目前吸烟的参与者比例下降了 41%，使用激素治疗的绝经后妇女比例增加了 175%，超重（定义为体重指数（公斤体重除以米身高的平方）为 25 或以上）的患病率增加了 38%。在研究期间，饮食得到了显着改善。从统计上看，当同时考虑时，这些变量的变化解释了冠心病发病率下降了 21%，占 1980-1982 年至 1992-1994 年总体下降率的 68%。单独来看，吸烟量的减少导致冠心病发病率下降 13%；饮食的改善解释了 16% 的下降；绝经后激素使用的增加解释了 9% 的下降。另一方面，体重指数的增加导致冠心病发病率增加 8%。 结论：减少吸烟、改善饮食以及增加绝经后激素的使用是该女性群体冠心病发病率下降的主要原因。然而，肥胖患病率的增加似乎减缓了冠心病发病率的下降。 （N Engl J Med 2000；343：530-7。）(C)2000，马萨诸塞州医学会。
Background: Previous studies have found concurrent declines in blood pressure, serum cholesterol levels, and the incidence of and mortality from coronary disease. However, the effects of changes in diet and lifestyle on trends in coronary disease are largely unknown.Methods: We followed 85,941 women who were 34 to 59 years old and had no previously diagnosed cardiovascular disease or cancer from 1980 to 1994 in the Nurses' Health Study. Diet and lifestyle variables were assessed at base line and updated during follow-up.Results: After adjustment for the effect of age, the incidence of coronary disease declined by 31 percent from the two-year period 1980-1982 to the two-year period 1992-1994. From 1980 to 1992, the proportion of participants currently smoking declined by 41 percent, the proportion of postmenopausal women using hormone therapy increased by 175 percent, and the prevalence of overweight, defined as a body-mass index (the weight in kilograms divided by the square of the height in meters) of 25 or more, increased by 38 percent. During the study period, diet improved substantially. Statistically, changes in these variables - when considered simultaneously - explained a 21 percent decline in the incidence of coronary disease, representing 68 percent of the overall decline from 1980-1982 to 1992-1994. Taken individually, the reduction in smoking explained a 13 percent decline in the incidence of coronary disease; improvement in diet explained a 16 percent decline; and increase in postmenopausal hormone use explained a 9 percent decline. On the other hand, the increase in body-mass index explained an 8 percent increase in the incidence of coronary disease.Conclusions: Reduction in smoking, improvement in diet, and an increase in postmenopausal hormone use accounted for much of the decline in the incidence of coronary disease in this group of women. An increasing prevalence of obesity, however, appears to have slowed the decline in the incidence of coronary disease. (N Engl J Med 2000;343:530-7.) (C)2000, Massachusetts Medical Society.