Traditional risk factors and the incidence of sudden coronary death with and without coronary thrombosis in blacks
Traditional risk factors and the incidence of sudden coronary death with and without coronary thrombosis in blacks
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DOI：
10.1161/hc0402.102952
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发表时间：
2002-01-29
期刊：
影响因子：
37.8
通讯作者：
Virmani, R
中科院分区：
文献类型：
--
作者：
Burke, AP;Farb, A;Virmani, R
背景——黑人冠心病猝死（SCD）的发生率很高。我们确定了州法医办公室记录的 6 年期间 30 至 69 岁男性和女性 SCID 的发生率。方法和结果 - 在 327 名白人和 130 名黑人的子集中，对心脏进行了系统研究，以确定冠状动脉疾病的程度、血栓的存在和类型（急性破裂、急性糜烂、稳定斑块）以及心脏重量。这些参数与常规风险因素的存在相关。 40 岁以下黑人的 SCD 估计发病率与白人相似，但随着年龄的增长，与白人相比有所增加，在 70 岁的时候成为白人的 1.5 倍（6 岁的增加的 95% 是由于稳定斑块猝死所致）。在患有严重冠状动脉粥样硬化的尸检组中，黑人中高密度脂蛋白胆固醇较高，高血压患病率较高，但愈合梗塞的患病率、斑块负荷、心脏重量、急性血栓或糖尿病、吸烟和总胆固醇的发生率没有差异。结论-与568例死亡的对照尸检组相比，多变量分析显示，黑人中稳定斑块与左心室肥厚之间存在显着相关性（风险比， 7.6）、I 型糖尿病（风险比，3.6）、高血压（风险比，3.5）、总胆固醇升高（风险比，3.1）和 2 型糖尿病（风险比，2.9）。由于这些危险因素与黑人的 SCD 相关，因此它们可能是降低黑人与白人相比极高的 SCD 发病率的重要目标。
Background-Blacks have a high rate of sudden coronary death (SCD). We determined the rate of SCID in men and women 30 to 69 years of age in a 6-year period recorded at a state Medical Examiner's Office.Methods and Results-In a subset of 327 whites and 130 blacks, hearts were systematically studied to determine the extent of coronary disease, presence and type of thrombus (acute rupture, acute erosion, stable plaque), and heart weight. These parameters were correlated with the presence of conventional risk factors. The estimated rate of SCD in blacks was similar to that in whites under the age of 40 years but increased compared with whites with advancing age, becoming 1.5 times the rate for whites in the 7th decade (95% of the increase in the 6th decade was due to sudden death with stable plaque). Among the autopsied group with severe coronary atherosclerosis, HDL cholesterol was higher and hypertension more prevalent in blacks, but there was no difference in the prevalence of healed infarcts, plaque burden, heart weight, acute thrombi, or rates of diabetes, cigarette smoking, and total cholesterol.Conclusions-When compared with a control autopsy group of 568 deaths, multivariate analysis showed a significant association in blacks between stable plaque and left ventricular hypertrophy (risk ratio, 7.6), type I diabetes (risk ratio, 3.6), hypertension (risk ratio, 3.5), elevated total cholesterol (risk ratio, 3.1) and type 2 diabetes (risk ratio, 2.9). Because these risk factors are associated with SCD in blacks, they may be important targets for reducing the disparately high rate of SCD in blacks as compared with whites.