Estimation of contribution of changes in classic risk factors to trends in coronary-event rates across the WHO MONICA Project populations
Estimation of contribution of changes in classic risk factors to trends in coronary-event rates across the WHO MONICA Project populations
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DOI：
10.1016/s0140-6736(99)11180-2
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发表时间：
2000-02-26
期刊：
影响因子：
168.9
通讯作者：
Tuomilehto, J
中科院分区：
文献类型：
--
作者：
Kuulasmaa, K;Tunstall-Pedoe, H;Tuomilehto, J
背景 从 20 世纪 80 年代中期到 90 年代中期，世界卫生组织 MONICA 项目监测了来自 21 个国家 38 个人群的冠状动脉事件和冠心病 (CHD) 的典型危险因素。我们评估了这些危险因素的变化在多大程度上解释了不同人群冠状动脉事件发生率趋势的变化。方法在 35-64 岁的男性和女性中，连续记录非致命性心肌梗死和冠状动脉死亡，以评估冠状动脉事件发生率的趋势。我们进行了人口调查来估计风险因素的趋势。事件发生率的趋势根据风险评分和个体风险因素的趋势进行回归。调查结果 大多数男性人群的吸烟率有所下降，但女性的趋势各不相同；平均血压和胆固醇浓度下降，体重指数增加，总体风险评分和冠状动脉事件发生率下降。 10 年冠状动脉事件发生率与风险评分和单一危险因素的趋势模型显示拟合度较差，但随着冠状动脉事件 4 年的滞后，这种情况得到了改善。由于估计的不精确性和研究人群趋势的同质性，分析的解释力受到限制。 解释 经典危险因素的变化似乎部分解释了 CHD 人群趋势的变化。剩余方差是由于测量和分析的困难（包括时间滞后）以及未包括在内的因素（例如医疗干预）造成的。结果支持基于经典风险因素的预防政策，但也表明了除这些因素之外的预防潜力。
Background From the mid-1980s to mid-1990s, the WHO MONICA Project monitored coronary events and classic risk factors for coronary heart disease (CHD) in 38 populations from 21 countries. We assessed the extent to which changes in these risk factors explain the variation in the trends in coronary-event rates across the populations.Methods In men and women aged 35-64 years, non-fatal myocardial infarction and coronary deaths were registered continuously to assess trends in rates of coronary events. We carried out population surveys to estimate trends in risk factors. Trends in event rates were regressed on trends in risk score and in individual risk factors.Findings Smoking rates decreased in most male populations but trends were mixed in women; mean blood pressures and cholesterol concentrations decreased, body-mass index increased, and overall risk scores and coronary-event rates decreased. The model of trends in 10-year coronary-event rates against risk scores and single risk factors showed a poor fit, but this was improved with a 4-year time lag for coronary events. The explanatory power of the analyses was limited by imprecision of the estimates and homogeneity of trends in the study populations.Interpretation Changes in the classic risk factors seem to partly explain the variation in population trends in CHD. Residual variance is attributable to difficulties in measurement and analysis, including time lag, and to factors that were not included, such as medical interventions. The results support prevention policies based on the classic risk factors but suggest potential for prevention beyond these.