Prediction of lifetime risk for cardiovascular disease by risk factor burden at 50 years of age
Prediction of lifetime risk for cardiovascular disease by risk factor burden at 50 years of age
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DOI：
10.1161/circulationaha.105.548206
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发表时间：
2006-02-14
期刊：
影响因子：
37.8
通讯作者：
Levy, D
中科院分区：
文献类型：
--
作者：
Lloyd-Jones, DM;Leip, EP;Levy, D
背景 - 动脉粥样硬化性心血管疾病 (CVD) 的终生风险此前尚未进行过估计，危险因素负担对终生风险的影响也是未知的。方法和结果 - 我们纳入了所有 50 岁时没有 CVD（心肌梗死、冠状动脉功能不全、心绞痛、中风、跛行）的弗雷明汉心脏研究参与者。对男性和女性 95 岁的终生风险进行了评估，并将无 CVD 的死亡作为一项竞争事件。我们对 3564 名男性和 4362 名女性进行了 111,777 人年的随访； 1757 人患有 CVD 事件，1641 人没有死于 CVD。 50岁时，男性终生风险为51.7%（95% CI，49.3至54.2），女性为39.2%（95% CI，37.0至41.4），中位生存期分别为30年和36年。随着单一危险因素的不利水平增加，终生风险增加，中位生存期减少。与≥ 2个主要危险因素的参与者相比，具有最佳水平的参与者的终生风险显着降低（男性为5.2%对68.9%，女性为8.2%对50.2%），中位生存期显着更长（男性> 39岁对28岁，女性> 39岁对31岁）。结论——50岁时没有既定风险因素与CVD终生风险极低和生存期显着延长相关。这些结果应促进旨在预防年轻人出现危险因素的努力。鉴于 50 岁时具有中度或高度危险因素负担的人终生风险较高且生存率较低，这些数据可能有助于传达风险和支持强化预防治疗。
Background-Lifetime risk for atherosclerotic cardiovascular disease ( CVD) has not previously been estimated, and the effect of risk factor burden on lifetime risk is unknown.Methods and Results-We included all Framingham Heart Study participants who were free of CVD ( myocardial infarction, coronary insufficiency, angina, stroke, claudication) at 50 years of age. Lifetime risks to 95 years of age were estimated for men and women, with death free of CVD as a competing event. We followed up 3564 men and 4362 women for 111 777 person-years; 1757 had CVD events and 1641 died free of CVD. At 50 years of age, lifetime risks were 51.7% (95% CI, 49.3 to 54.2) for men and 39.2% (95% CI, 37.0 to 41.4) for women, with median survivals of 30 and 36 years, respectively. With more adverse levels of single risk factors, lifetime risks increased and median survivals decreased. Compared with participants with >= 2 major risk factors, those with optimal levels had substantially lower lifetime risks (5.2% versus 68.9% in men, 8.2% versus 50.2% in women) and markedly longer median survivals (> 39 versus 28 years in men, > 39 versus 31 years in women).Conclusions-The absence of established risk factors at 50 years of age is associated with very low lifetime risk for CVD and markedly longer survival. These results should promote efforts aimed at preventing development of risk factors in young individuals. Given the high lifetime risks and lower survival in those with intermediate or high risk factor burden at 50 years of age, these data may be useful in communicating risks and supporting intensive preventive therapy.