Perreault S, Dorais M, Coupal L, Paradis G, Joffres M R, Grover S A
Centre for the Analysis of Cost-Effective Care, Montreal General Hospital, Que.
CMAJ. 1999 May 18;160(10):1449-55.
To compare the prevalence of modifiable risk factors for cardiovascular disease among hypertensive and nonhypertensive adults and to estimate the effect of treating hyperlipidemia or hypertension to reduce the risk of death from coronary artery disease.
The authors evaluated a sample of 7814 subjects aged 35-74 years free of clinical cardiovascular disease from the Canadian Heart Health Surveys to estimate the prevalence of cardiovascular risk factors. They identified hyperlipidemic subjects (ratio of total cholesterol to high-density lipoprotein cholesterol [total-C/HDL-C] 6.0 [corrected] or more for men and 5.0 [corrected] or more for women) and hypertensive subjects (systolic or diastolic blood pressure 160/90 mm Hg or greater, or receiving pharmacologic or nonpharmacologic treatment). A life expectancy model was used to estimate the rate of death from coronary artery disease following specific treatments.
An elevated total-C/HDL-C ratio was significantly more common among hypertensive than nonhypertensive men aged 35-64 (rate ratio [RR] 1.56 for age 35-54, 1.28 for age 55-64) and among hypertensive than nonhypertensive women of all ages (RR 2.73 for age 35-54, 1.58 for age 55-64, 1.31 for age 65-74). Obesity and a sedentary lifestyle were also more common among hypertensive than among nonhypertensive subjects. According to the model, more deaths from coronary artery disease could be prevented among subjects with treated but uncontrolled hypertension by modifying lipids rather than by further reducing blood pressure for men aged 35-54 (reduction of 50 v. 29 deaths per 100,000) and 55-64 (reduction of 171 v. 104 deaths per 100,000) and for women aged 35-54 (reduction of 44 v. 39 deaths per 100,000). Starting antihypertensive therapy in subjects aged 35-74 with untreated hypertension would achieve a greater net reduction in deaths from coronary artery disease than would lipid lowering. Nonetheless, the benefits of lipid therapy were substantial: lipid intervention among hypertensive subjects aged 35-74 represented 36% of the total benefits of treating hyperlipidemia in the total hyperlipidemic population.
The clustering of hyperlipidemia and the potential benefits of treatment among hypertensive adults demonstrate the need for screening and treating other cardiovascular risk factors beyond simply controlling blood pressure.
比较高血压和非高血压成年人中可改变的心血管疾病危险因素的患病率，并评估治疗高脂血症或高血压对降低冠状动脉疾病死亡风险的效果。
作者评估了来自加拿大心脏健康调查的7814名年龄在35 - 74岁且无临床心血管疾病的受试者样本，以估计心血管危险因素的患病率。他们确定了高脂血症患者（男性总胆固醇与高密度脂蛋白胆固醇之比[总胆固醇/高密度脂蛋白胆固醇（total-C/HDL-C）]校正后为6.0或更高，女性校正后为5.0或更高）和高血压患者（收缩压或舒张压为160/90 mmHg或更高，或正在接受药物或非药物治疗）。使用寿命预期模型来估计特定治疗后冠状动脉疾病的死亡率。
在35 - 64岁的高血压男性中，总胆固醇/高密度脂蛋白胆固醇比值升高比非高血压男性更常见（35 - 54岁时率比[RR]为1.56，55 - 64岁时为1.28），在各年龄段的高血压女性中也比非高血压女性更常见（35 - 54岁时RR为2.73，55 - 64岁时为1.58，65 - 74岁时为1.31）。肥胖和久坐不动的生活方式在高血压患者中也比非高血压患者更常见。根据模型，对于35 - 54岁的男性（每10万人中减少50例死亡对29例）和55 - 64岁的男性（每10万人中减少171例死亡对104例）以及35 - 54岁的女性（每10万人中减少44例死亡对39例），通过调整血脂而非进一步降低血压，可以预防更多接受治疗但血压未得到控制的高血压患者死于冠状动脉疾病。在35 - 74岁未治疗的高血压患者中开始抗高血压治疗，与降低血脂相比，将实现更大幅度的冠状动脉疾病死亡净减少。尽管如此，降脂治疗的益处仍然很大：在35 - 74岁的高血压患者中进行降脂干预占高脂血症总体人群降脂治疗总益处的36%。
高脂血症在高血压成年人中的聚集以及治疗的潜在益处表明，除了单纯控制血压外，还需要筛查和治疗其他心血管危险因素。
