Contributions of risk factors and medical care to cardiovascular mortality trends.
Contributions of risk factors and medical care to cardiovascular mortality trends.
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DOI：
10.1038/nrcardio.2015.82
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发表时间：
2015-09
期刊：
影响因子：
--
通讯作者：
Leon DA
中科院分区：
文献类型：
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作者：
Ezzati M;Obermeyer Z;Tzoulaki I;Mayosi BM;Elliott P;Leon DA
缺血性心脏病、中风和其他心血管疾病（CVD）每年造成全球约1750万人死亡。如果考虑到人口老龄化，估计全世界以及有可靠趋势数据的地区的心血管疾病死亡率将稳步下降。高收入国家和拉丁美洲一些国家的下降已经持续了几十年，没有减缓的迹象。在高收入国家，这些积极趋势与吸烟和血压和血清胆固醇等生理风险因素的下降大致一致，并从中受益。医疗保健的改善，包括通过管理生理风险因素进行有效的一级预防，更好地诊断和治疗急性心血管疾病，以及对既往心血管疾病患者的院后护理，也可能有助于降低心血管疾病事件和死亡率，特别是在过去40年中。然而，测量的风险因素和治疗变量既不能解释为什么下降开始时，也没有太多的相似性和差异的开始时间和下降率的国家之间或男性和女性之间。自20世纪90年代初共产主义垮台以来，欧洲和苏联的前共产主义国家的心血管疾病发生了急剧变化和波动，饮酒量和饮酒模式发生了变化，这是俄罗斯和其他一些前苏联国家发病率上升的主要原因。在过去半个世纪中，对构成成人死亡率最显着的国际趋势之一的驱动因素得出更明确的结论的挑战部分反映了时间趋势数据的缺乏，不仅是关于疾病发病率，风险因素和临床护理，而且还有其他潜在的驱动因素，包括整个生命过程中的感染和相关炎症过程。
Ischaemic heart disease, stroke, and other cardiovascular diseases (CVDs) are responsible for an estimated 17.5 million annual deaths in the world. If account is taken of population aging, death rates from CVDs are estimated to be steadily decreasing in the world as a whole, and in regions with reliable trend data. The declines in high-income countries and some countries in Latin America have been ongoing for decades with no indication of slowing. In high-income countries, these positive trends have broadly coincided with, and benefited from, declines in smoking and physiological risk factors like blood pressure and serum cholesterol. Improvements in medical care, including effective primary prevention through management of physiological risk factors, better diagnosis and treatment of acute CVDs, and post-hospital care of those with prior CVDs, are also likely to have contributed to declining CVD event and death rates, especially in the past 40 years. However, the measured risk factor and treatment variables neither explain why the decline began when it did, nor much of the similarities and differences in the start time and rate of the decline across countries or between men and women. There have been sharp changes and fluctuations in CVDs in the former communist countries of Europe and the Soviet Union since the fall of communism in the early 1990s, with changes in volume and patterns of alcohol drinking, as a major cause of the rise in Russia and some other former Soviet countries. The challenge of reaching more definitive conclusions concerning the drivers of what constitutes one of the most remarkable international trends in adult mortality in the past half-century in part reflects the paucity of time trend data not only on disease incidence, risk factors, and clinical care, but also on other potential drivers, including infection and associated inflammatory processes throughout the lifecourse.