Joint effects of systolic blood pressure and serum cholesterol on cardiovascular disease in the Asia Pacific region
Joint effects of systolic blood pressure and serum cholesterol on cardiovascular disease in the Asia Pacific region
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DOI：
10.1161/circulationha.105.537472
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发表时间：
2005-11-29
期刊：
影响因子：
37.8
通讯作者：
Rodgers, A
中科院分区：
文献类型：
--
作者：
Rodgers, A
背景 - 尽管人们对心血管疾病多因素干预措施的兴趣日益浓厚，但有关血压和胆固醇水平对心血管疾病风险的联合影响的强度和形状的数据却很少，主要局限于西方中年早期人群的冠心病 (CHD) 死亡率。方法和结果 - 这项分析包括来自亚洲的 29 个队列（占 380 216 名参与者总数的 78%）以及来自澳大利亚和新西兰的 7 个队列，总计 2 547 447 名参与者人-年的观察。分层时间依赖性 Cox 比例风险分析用于根据基线收缩压 (SBP) 和总胆固醇水平回归首次事件发生之前的时间。总共发生了3079起冠心病和4247起中风事件；在 1471 例（35%）中风事件中，通过 CT、MRI 或尸检证实了中风亚型。 SBP 的常用值与缺血性中风、出血性中风和 CHD 呈强线性相关。随着缺血性中风 (P = 0.007) 和 CHD (P = 0.0001) 胆固醇水平的降低，与 SBP 的相关性斜率变得更陡。例如，对于< 4.75、4.75至5.49、5.50至6.24和≥ 6.25 mmol/L的胆固醇组，收缩压每升高10 mm Hg，与34%（95% CI，30%至37%）、28%（95% CI，21%至35%）、冠心病风险分别增加 25%（95% CI，18% 至 32%）和 21%（95% CI，13% 至 27%）。对其他主要心血管危险因素进行调整后，这些结果没有明显差异。 结论 - 在亚太地区人群中，所有胆固醇水平的 SBP 均存在升高的危险，并且所有 SBP 水平的胆固醇升高都有风险，但在胆固醇水平较低的人群中，SBP 与 CHD 风险和缺血性中风风险的关联性稍显陡峭。收缩压和总胆固醇对心血管疾病的联合影响在不同的西方和亚洲人群中似乎是一致的。
Background - Although interest in multifactorial interventions for cardiovascular disease is increasing, data on the strength and shape of the joint effects of blood pressure and cholesterol levels on the risk of cardiovascular disease are scarce, confined primarily to coronary heart disease ( CHD) mortality in early middle- aged Western populations.Methods and Results - This analysis included 29 cohorts from Asia ( 78% of the total 380 216 participants) and 7 from Australia and New Zealand, with a total of 2 547 447 person- years of observation. Stratified time- dependent Cox proportional- hazards analyses were used to regress time until first event against baseline systolic blood pressure ( SBP) and total cholesterol levels. A total of 3079 CHD and 4247 stroke events occurred; stroke subtypes were confirmed by CT, MRI, or necropsy in 1471 ( 35%) stroke events. Usual values of SBP were strongly linearly associated with ischemic stroke, hemorrhagic stroke, and CHD. The slope of the association with SBP became steeper with decreasing levels of cholesterol for ischemic stroke ( P = 0.007) and CHD ( P = 0.0001). For example, for the cholesterol groups of < 4.75, 4.75 to 5.49, 5.50 to 6.24, and >= 6.25 mmol/ L, each 10 - mm Hg - higher systolic pressure was associated with 34% ( 95% CI, 30% to 37%), 28% ( 95% CI, 21% to 35%), 25% ( 95% CI, 18% to 32%), and 21% ( 95% CI, 13% to 27%) higher CHD risk, respectively. Adjustments for other leading cardiovascular risk factors made no appreciable differences in these results.Conclusions - In Asia- Pacific populations, there are hazards of increasing SBP at all cholesterol levels and hazards of increasing cholesterol at all levels of SBP, but the associations of SBP with CHD risk and ischemic stroke risk are slightly steeper among those with low cholesterol levels. The joint effects of SBP and total cholesterol on cardiovascular disease seem consistent across various Western and Asian populations.