Incidence of cardiovascular disease and cancer in advanced age: prospective cohort study.
Incidence of cardiovascular disease and cancer in advanced age: prospective cohort study.
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高龄心血管疾病和癌症的发病率：前瞻性队列研究。
DOI：
10.1136/bmj.a2467
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发表时间：
2008-12-09
期刊：
影响因子：
--
通讯作者：
Kurth T
中科院分区：
文献类型：
--
作者：
Driver JA;Djoussé L;Logroscino G;Gaziano JM;Kurth T
目的探讨老年男性人群中年龄增长对心血管疾病和癌症发病率及终生风险的影响。设计前瞻性队列研究。背景是美国。研究对象1982年无大病史的男性医生22 048人，年龄40~84岁。主要结果衡量主要心血管疾病(心肌梗塞、中风和心血管疾病死亡)和癌症的发病率和剩余终身风险。结果经23年随访，确诊主要心血管事件3252例，发生癌症5400例。重大心血管疾病的发病率持续增加到100岁。然而，从80岁开始，重大心血管疾病更有可能在死亡时被诊断出来。癌症的发病率在80岁的人中达到顶峰----然后下降。通过筛查发现的癌症是下降的主要原因，而大多数没有筛查的癌症在100岁之前继续增加。未经调整的累积发病率高估了16%的心血管疾病风险和8.5%的癌症风险。40岁时患癌症的剩余终身风险为45.1%(95%可信区间为43.8%至46.3%)，90岁时为9.6%(7.2%至11.9%)。40岁时患主要心血管疾病的剩余终身风险为34.8%(33.1%至36.5%)，90岁时为16.7%(12.9%至20.6%)。结论在这一男性前瞻性队列中，新的心血管疾病的发病率在80岁以后继续增加，但最常见的是在死亡时被诊断出来。晚年癌症发病率的下降似乎在很大程度上是由于筛查通常发现的癌症的减少。这些发现表明，80岁及以上的人有大量未诊断的疾病。这两种疾病的剩余终身风险在第10个十年接近平台期。这可能是由于那些活到老年的人减少了疾病检测和症状报告，并增强了对疾病的抵抗力。对老龄化人口中疾病风险的准确估计需要对相互竞争的死亡风险进行调整。
Objective To investigate the influence of increasing age on the incidence and remaining lifetime risk of cardiovascular disease and cancer in a cohort of older men. Design Prospective cohort study. Setting United States. Participants 22 048 male doctors aged 40-84 who were free of major disease in 1982. Main outcome measures Incidence and remaining lifetime risk of major cardiovascular disease (myocardial infarction, stroke, and death from cardiovascular disease) and cancer. Results 3252 major cardiovascular events and 5400 incident cancers were confirmed over 23 years of follow-up. The incidence of major cardiovascular disease continued to increase to age 100. Beginning at age 80, however, major cardiovascular disease was more likely to be diagnosed at death. The incidence of cancer peaked in those aged 80-89 and then declined. Cancers detected by screening accounted for most of the decline, whereas most cancers for which there was no screening continued to increase to age 100. Unadjusted cumulative incidence overestimated the risk of cardiovascular disease by 16% and cancer by 8.5%. The remaining lifetime risk of cancer at age 40 was 45.1% (95% confidence interval 43.8% to 46.3%) and at age 90 was 9.6% (7.2% to 11.9%). The remaining lifetime risk of major cardiovascular disease at age 40 was 34.8% (33.1% to 36.5%) and at age 90 was 16.7% (12.9% to 20.6%). Conclusions In this prospective cohort of men, the incidence of new cardiovascular disease continued to increase after age 80 but was most often diagnosed at death. The decrease in incidence of cancer late in life seemed largely due to a decline in cancers usually detected by screening. These findings suggest that people aged 80 and older have a substantial amount of undiagnosed disease. The remaining lifetime risk of both diseases approached a plateau in the 10th decade. This may be due to decreased detection of disease and reporting of symptoms and increased resistance to disease in those who survive to old age. Accurate estimates of disease risk in an aging population require adjustment for competing risks of mortality.
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影响因子：
9.9
作者：
Seshadri, S;Wolf, PA;D'Agostino, RB
通讯作者：
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37.8
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影响因子：
158.5
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通讯作者：
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