Predictors of cardiovascular events and mortality in the Systolic Hypertension in the Elderly Program pilot project.
Predictors of cardiovascular events and mortality in the Systolic Hypertension in the Elderly Program pilot project.
复制标题
老年人收缩期高血压试点项目中心血管事件和死亡率的预测因素。
DOI：
10.1093/oxfordjournals.aje.a114670
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发表时间：
1987
影响因子：
5
通讯作者：
Hulley,SB
中科院分区：
文献类型：
--
作者：
Siegel,D;Kuller,L;Lazarus,NB;Black,D;Feigal,D;Hughes,G;Schoenberger,JA;Hulley,SB
Siegel, D.（临床流行病学项目，旧金山综合医院，旧金山，CA 94110）、L. Kuller、N. B. Lazarus、D. Black、D. Feigal、G. Hughes、J. A. Schoenberger 和 S. B. Hulley。老年人收缩期高血压计划试点项目中心血管事件和死亡率的预测因素。Am J Epidemiol1987；126：385-99。已确定的年轻人心血管危险因素仍然是老年人心血管疾病事件和死亡率的重要预测因素吗？作者在老年人收缩性高血压计划试点项目中研究了这个问题，该项目对 1981 年 5 月至 1982 年 7 月期间入组的 551 名 60 岁及以上男性和女性进行了前瞻性随访，这些男性和女性治疗前收缩压≥160 mmHg，舒张压 <90 mmHg。平均年龄为 72 岁，37% 为男性，82% 为白人，24% 曾参加过该项目大学。所有 551 名参与者的生命状况在随访结束时（平均入组后 34 个月）已知；共有 39 例因各种原因死亡，66 例首次心血管事件，18 例中风，以及 20 例心肌梗塞/猝死。单变量 Cox 比例风险分析显示，年龄是全因死亡率、首次心血管事件和中风的预测因子 (p < 0.05)。低于大学教育是全因死亡率和首次心血管事件的预测因素，吸烟是首次心血管事件和心肌梗死/猝死的预测因素，胆固醇是首次心血管事件的预测因素，较低的体重指数是全因死亡率增加的预测因素。调整可变量后，年龄、较低教育程度、较低体重指数和基线心电图异常是全因死亡率的显着预测因素，而年龄、较低教育程度、心血管事件史和吸烟仍然是首次心血管事件的显着预测因素。性别不是危险因素，而且由于整个队列在基线时都患有收缩期高血压，而且大多数人都接受了治疗，因此检查高血压作为危险因素的能力受到了损害。这些发现与先前的证据相结合，表明吸烟、低教育水平以及血清胆固醇可能是老年人心血管疾病的危险因素。尽管这些因素带来的超额风险很大，但其可逆性需要通过干预研究来证明。
Siegel, D. (Clinical Epidemiology Program, San Francisco General Hospital, San Francisco, CA 94110), L. Kuller, N. B. Lazarus, D. Black, D. Feigal, G. Hughes, J. A. Schoenberger, and S. B. Hulley. Predictors of cardiovascular events and mortality in the Systolic Hypertension in the Elderly Program pilot project.Am J Epidemiol1987;126:385-99.Do the established cardiovascular risk factors for younger persons remain important predictors of cardiovascular disease events and mortality in those who are older? The authors examined this question in the Systolic Hypertension in the Elderly Program pilot project which prospectively followed 551 men and women 60 years of age and older with pretreatment systolic blood pressure ≥160 mmHg and diastolic blood pressure <90 mmHg who were enrolled between May 1981 and July 1982. Mean age was 72 years, 37% were men, 82% were white, and 24% had attended college. The vital status of all 551 participants was known at the end of follow-up, an average of 34 months after entry; there were 39 deaths from all causes, 66 first cardiovascular events, 18 strokes, and 20 episodes of myocardial infarction/sudden death. Univariate Cox proportional hazard analysis revealed that age was a predictor (p < 0.05) of all-cause mortality, first cardio vascular event, and stroke. Less than college education was a predictor of all-cause mortality and first cardiovascular event, smoking was a predictor of first cardiovascular event and myocardial infarction/sudden death, cholesterol was a predictor of first cardiovascular event, and lower body mass index was a predictor of increased all-cause mortality. After adjustment for covanables, age, lower education, lower body mass index, and baseline electrocardiographic abnormal ities were significant predictors of all-cause mortality, and age, lower education, history of cardiovascular event, and smoking remained significant predictors of first cardiovascular event. Sex was not a risk factor, and the ability to examine hypertension as a risk factor was impaired by the fact that the entire cohort had systolic hypertension at baseline, and most were treated. These findings, com bined with prior evidence, suggest that smoking, low education level, and perhaps serum cholesterol are risk factors for cardiovascular disease in the elderly. Although the excess risk conveyed by these factors is large, its reversibility needs to be demonstrated by intervention studies.