Reverse Epidemiology of Traditional Cardiovascular Risk Factors in the Geriatric Population.
Reverse Epidemiology of Traditional Cardiovascular Risk Factors in the Geriatric Population.
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DOI：
10.1016/j.jamda.2015.07.014
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发表时间：
2015-11-01
影响因子：
7.6
通讯作者：
Kalantar-Zadeh K
中科院分区：
文献类型：
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作者：
Ahmadi SF;Streja E;Zahmatkesh G;Streja D;Kashyap M;Moradi H;Molnar MZ;Reddy U;Amin AN;Kovesdy CP;Kalantar-Zadeh K
一般人群中心血管死亡的传统危险因素，包括体重指数(BMI)、血清胆固醇和血压(BP)，也被发现与老年人群的结局有关，但相反。据报道，某些程度的BMI、血清胆固醇和血压升高与老年人的死亡风险较低而不是较高有关。这种现象被称为“反向流行病学”或“危险因素悖论”(如肥胖悖论)，也可见于各种慢性疾病状态，如需要透析的终末期肾病、慢性心力衰竭、类风湿性关节炎和艾滋病。几种可能的原因被假设来解释这种危险因素的逆转：竞争的短期和长期杀手，肥胖者血液动力学稳定性的改善，脂肪因子对肿瘤坏死因子-α的保护，脂蛋白对内毒素的保护，以及脂肪组织对亲脂毒素的隔离。目前基于年轻人群得出的BMI、血清胆固醇和血压等传统危险因素的干预阈值和目标水平可能不适用于老年人，应该为老年人口制定这些危险因素的新水平。常规心血管危险因素的反向流行病学可能会影响老年人群的管理，因此值得进一步关注。
Traditional risk factors of cardiovascular death in the general population, including body mass index (BMI), serum cholesterol, and blood pressure (BP), are also found to relate to outcomes in the geriatric population, but in an opposite direction. Some degrees of elevated BMI, serum cholesterols, and BP are reportedly associated with lower – instead of higher – risk of death among the elderly. This phenomenon is termed “reverse epidemiology” or “risk factor paradox” (such as obesity paradox) and is also observed in a variety of chronic disease states such as end-stage renal disease requiring dialysis, chronic heart failure, rheumatoid arthritis, and AIDS. Several possible causes are hypothesized to explain this risk factor reversal: competing short-term and long-term killers, improved hemodynamic stability in the obese, adipokine protection against tumor necrosis factor-α, lipoprotein protection against endotoxins, and lipophilic toxin sequestration by the adipose tissue. It is possible that the current thresholds for intervention and goals levels for such traditional risk factors as BMI, serum cholesterol, and BP derived based on younger populations do not apply to the elderly, and that new levels for such risk factors should be developed for the elderly population. Reverse epidemiology of conventional cardiovascular risk factors may have a bearing on the management of the geriatric population, thus it deserves further attention.