Lloyd-Jones D M, Larson M G, Beiser A, Levy D
National Heart, Lung, and Blood Institute's Framingham Heart Study, National Institutes of Health, Massachusetts 01702, USA.
Lancet. 1999 Jan 9;353(9147):89-92. doi: 10.1016/S0140-6736(98)10279-9.
The lifetime risk of developing coronary heart disease has not been estimated in a general population. We investigated the lifetime risks of initial coronary events at different ages.
We assessed data for 7733 participants in the Framingham Heart Study, who had been examined at least once at age 40-94 years between 1971 and 1975, found to be free of coronary heart disease, and then followed up. We estimated the lifetime risks of coronary heart disease (angina pectoris, coronary insufficiency, myocardial infarction, or death from coronary heart disease) by multiple-decrement life-table methods.
The 7733 patients were followed up for a total of 109,948 person-years. Overall, 1157 participants developed coronary heart disease. 1312 died from non-coronary heart disease causes. Lifetime risk of coronary heart disease at age 40 years was 48.6% (95% CI 45.8-51.3) for men and 31.7% (29.2-34.2) for women. At age 70 years, lifetime risk was 34.9% (31.2-38.7) for men and 24.2% (21.4-27.0) for women. After we excluded isolated angina pectoris as an initial event, the lifetime risk of coronary artery disease events at age 40 years was 42.4% for men and 24.9% for women.
Lifetime risk at age 40 years is one in two for men and one in three for women. Even at age 70 years it is one in three for men and one in four for women. This knowledge may promote efforts in education, screening, and treatment for prevention of coronary heart disease in younger and older patients.
尚未在普通人群中估计患冠心病的终生风险。我们调查了不同年龄首次发生冠心病事件的终生风险。
我们评估了弗雷明汉心脏研究中7733名参与者的数据，这些参与者在1971年至1975年期间年龄在40 - 94岁之间至少接受过一次检查，当时被发现无冠心病，随后进行随访。我们采用多重递减寿命表法估计冠心病（心绞痛、冠状动脉供血不足、心肌梗死或冠心病死亡）的终生风险。
7733名患者总共随访了109948人年。总体而言，1157名参与者患了冠心病。1312人死于非冠心病原因。40岁时男性患冠心病的终生风险为48.6%（95%可信区间45.8 - 51.3），女性为31.7%（29.2 - 34.2）。70岁时，男性终生风险为34.9%（31.2 - 38.7），女性为24.2%（21.4 - 27.0）。在我们将孤立性心绞痛排除在初始事件之外后，40岁时男性冠心病事件的终生风险为42.4%，女性为24.9%。
40岁时男性终生风险为二分之一，女性为三分之一。即使在70岁时，男性为三分之一，女性为四分之一。这一认识可能会促进针对年轻和老年患者预防冠心病的教育、筛查和治疗工作。
