Major risk factors as antecedents of fatal and nonfatal coronary heart disease events
Major risk factors as antecedents of fatal and nonfatal coronary heart disease events
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DOI：
10.1001/jama.290.7.891
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发表时间：
2003-08-20
影响因子：
120.7
通讯作者：
Wilson, PW
中科院分区：
文献类型：
--
作者：
Greenland, P;Knoll, MD;Wilson, PW
背景一个经常被引用的概念是，在许多冠心病患者(可能有50%)中，缺乏导致冠心病(CHD)的个体主要危险因素。目的确定冠心病患者暴露于主要危险因素的频率。设计、环境和参与者包括三项前瞻性队列研究：芝加哥心脏协会工业检测项目，人口样本为35642名18至59岁的受雇男性和女性；多风险因素干预试验的筛查对象，包括347978名年龄在35岁至57岁的男性；来自弗雷明翰心脏研究(FHS)的3295名年龄在34岁到59岁之间的男性和女性的人口样本。所有研究对象的随访期为21到30年。主要结果是通过暴露于主要的CHD危险因素来衡量所有队列中的致命性冠心病和FHS中的非致命性心肌梗死(MI)，主要危险因素定义为总胆固醇至少为240 mg/dL(大于或等于6.22 mmol/L)、收缩压至少140 mm Hg、舒张压至少90 mm Hg、吸烟和糖尿病。参与者按性别和年龄分层(18-39岁对40-59岁)。结果在致命性冠心病(n=20995)中，暴露于至少一个临床升高的主要危险因素的比例从87%到100%不等。在基线年龄为40至59岁的致命冠心病患者(n=19263)中，暴露于至少一个主要危险因素的范围从87%至94%不等。对于非致命性心肌梗死，基线年龄40~59岁的男性中有92%(95%CI，87%~96%)(n=167)有既往暴露，该年龄段女性中有87%(95%CI，80%~94%)(n=94)有既往暴露。结论先期主要CHD危险因素暴露在发生CHD的人群中非常常见，强调在确定CHD风险估计和试图预防临床CHD时考虑所有主要危险因素的重要性。这些结果挑战了这样的说法，即冠心病事件通常发生在没有接触至少一个主要冠心病风险因素的人中。
Context A frequently cited concept is that individual major risk factors for coronary heart disease (CHD) are absent in many patients (perhaps >50%) with CHD. However, prior studies have not systematically evaluated the extent to which CHD patients have previous exposure to at least 1 risk factor, including diabetes, cigarette smoking, or clinically elevated levels of cholesterol or blood pressure.Objective To determine the, frequency of exposure to major CHD risk factors.Design, Setting, and Participants Three prospective cohort studies were included: the Chicago Heart Association Detection Project in Industry, with a population sample of 35642 employed men and women aged 18 to 59 years; screenees for the Multiple Risk Factor Intervention Trial, including 347978 men aged 35 to 57 years; and a population-based sample of 3295 men and women aged 34 to 59 years from the Framingham Heart Study (FHS). Follow-up lasted 21 to 30 years across the studies.Main Outcome Measures Fatal CHD in all cohorts and nonfatal myocardial infarction (MI) in the FHS, compared by exposure to major CHD risk factors, defined as total cholesterol of at least 240 mg/dL (greater than or equal to6.22 mmol/L), systolic blood pressure of at least 140 mm Hg, diastolic blood pressure of at least 90 mm Hg, cigarette smoking, and diabetes. Participants were stratified by sex and age (18-39 vs 40-59 years).Results For fatal CHD (n=20995), exposure to at least 1 clinically elevated major risk factor ranged from 87% to 100%. Among those aged 40 to 59 years at baseline with fatal CHD (n=19263), exposure to at least 1 major risk factor ranged from 87% to 94%. For nonfatal MI, prior exposure was documented in 92% (95% Cl, 87%-96%) (n=167) of men aged 40 to 59 years at baseline and in 87% (95% Cl, 80%-94%) (n=94) of women in this age group.Conclusions Antecedent major CHD risk factor exposures were very common among those who developed CHD, emphasizing the importance of considering all major risk factors in determining CHD risk estimation and in attempting to prevent clinical CHD. These results challenge claims that CHD events commonly occur in persons without exposure to at least 1 major CHD risk factor.