Leucocyte telomere length and risk of cardiovascular disease: systematic review and meta-analysis.
Leucocyte telomere length and risk of cardiovascular disease: systematic review and meta-analysis.
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DOI：
10.1136/bmj.g4227
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发表时间：
2014-07-08
期刊：
影响因子：
--
通讯作者：
Willeit P
中科院分区：
文献类型：
--
作者：
Haycock PC;Heydon EE;Kaptoge S;Butterworth AS;Thompson A;Willeit P
目的探讨白细胞端粒长度与心血管疾病的关系。设计系统综述和荟萃分析。数据来源：通过检索Medline、Web of Science和Embase，确定了截至2014年3月发表的研究。报告白细胞端粒长度与冠心病相关性的前瞻性和回顾性研究（定义为非致死性心肌梗死、冠心病死亡或冠状动脉血运重建）或脑血管疾病（定义为非致命性中风或脑血管疾病死亡），广泛代表一般人群，他们没有根据先前存在的心血管疾病或糖尿病选择队列或对照参与者。结果纳入24篇研究，共纳入43 725例受试者，8400例心血管疾病患者，其中冠心病5566例，脑血管病2834例。在比较白细胞端粒长度的最短与最长三分之一时，冠心病的合并相对危险度在所有研究中为1.54（95%置信区间1.30至1.83），在前瞻性研究中为1.40（1.15至1.70），在回顾性研究中为1.80（1.32至2.44）。研究之间的异质性是中等的（I2= 64%，41%至77%，Phet<0.001），并且没有被参与者的平均年龄（P=0.23），男性参与者的比例（P=0.45）或回顾性与前瞻性研究之间的差异（P=0.32）显著解释。在仅限于校正了传统血管危险因素的研究的荟萃分析中，冠心病的结果相似（相对风险1.42，95%置信区间1.17至1.73）; ≥200例病例的研究（1.44，1.20至1.74）;高质量评分的研究（1.53，1.22至1.92）;以及校正发表偏倚的分析（1.34，1.12至1.60）。脑血管疾病的合并相对危险度为1.42（1.11 - 1.81），研究间无显著异质性（I2= 41%，0%-72%，Phet=0.08）。在前瞻性研究（1.14，0.85至1.54）或高质量评分研究（1.21，0.83至1.76）中，较短的端粒与脑血管疾病风险无显著相关性。结论白细胞端粒长度与冠心病发病风险呈负相关，与传统的血管危险因素无关。与脑血管疾病的关系不太确定。
Objective To assess the association between leucocyte telomere length and risk of cardiovascular disease. Design Systematic review and meta-analysis. Data sources Studies published up to March 2014 identified through searches of Medline, Web of Science, and Embase. Eligibility criteria Prospective and retrospective studies that reported on associations between leucocyte telomere length and coronary heart disease (defined as non-fatal myocardial infarction, coronary heart disease death, or coronary revascularisation) or cerebrovascular disease (defined as non-fatal stroke or death from cerebrovascular disease) and were broadly representative of general populations—that is, they did not select cohort or control participants on the basis of pre-existing cardiovascular disease or diabetes. Results Twenty four studies involving 43 725 participants and 8400 patients with cardiovascular disease (5566 with coronary heart disease and 2834 with cerebrovascular disease) were found to be eligible. In a comparison of the shortest versus longest third of leucocyte telomere length, the pooled relative risk for coronary heart disease was 1.54 (95% confidence interval 1.30 to 1.83) in all studies, 1.40 (1.15 to 1.70) in prospective studies, and 1.80 (1.32 to 2.44) in retrospective studies. Heterogeneity between studies was moderate (I2=64%, 41% to 77%, Phet<0.001) and was not significantly explained by mean age of participants (P=0.23), the proportion of male participants (P=0.45), or distinction between retrospective versus prospective studies (P=0.32). Findings for coronary heart disease were similar in meta-analyses restricted to studies that adjusted for conventional vascular risk factors (relative risk 1.42, 95% confidence interval 1.17 to 1.73); studies with ≥200 cases (1.44, 1.20 to 1.74); studies with a high quality score (1.53, 1.22 to 1.92); and in analyses that corrected for publication bias (1.34, 1.12 to 1.60). The pooled relative risk for cerebrovascular disease was 1.42 (1.11 to 1.81), with no significant heterogeneity between studies (I2=41%, 0% to 72%, Phet=0.08). Shorter telomeres were not significantly associated with cerebrovascular disease risk in prospective studies (1.14, 0.85 to 1.54) or in studies with a high quality score (1.21, 0.83 to 1.76). Conclusion Available observational data show an inverse association between leucocyte telomere length and risk of coronary heart disease independent of conventional vascular risk factors. The association with cerebrovascular disease is less certain.
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