视网膜静脉阻塞患者的心血管风险评估
Cardiovascular risk assessment in patients with retinal vein occlusion.
作者信息
Martin S C, Butcher A, Martin N, Farmer J, Dobson P M, Bartlett W A, Jones A F
机构信息
Department of Clinical Biochemistry and Immunology, Heartlands Hospital, Birmingham, UK.
出版信息
Br J Ophthalmol. 2002 Jul;86(7):774-6. doi: 10.1136/bjo.86.7.774.
AIM
Patients with retinal vein occlusions (RVO) are at increased risk of cardiovascular disease (CVD). The risk of future CVD was determined using the Framingham algorithm and this risk estimate was used to guide decisions about preventative treatment for CVD in RVO patients.
METHODS
107 unselected RVO patients were studied. After excluding 18 patients because of age, missing data, or pre-existing cardiovascular disease, the calculated coronary heart disease risks (cCHDR) and calculated cardiovascular disease risks (cCVDR) were calculated on the 89 remaining and compared with both the standardised risk and the published incidence of CHD in England by t test or chi(2) test.
RESULTS
The mean 10 year cCVDR was significantly higher than the Framingham standardised risk for all RVOs (20.6% (1.2%) v 15.7% (1.1%), p = 0.009) and female RVOs (17.8% (1.2%) v 12.7% (1.0%), p = 0.022) in particular. The 10 year cCHDR, compared to the actual incidence of CHD in England between the ages of 30 and 74 years, was > 15% in twice as many males than expected (62% v 28%, p <0.0001). This rose to almost six times when cCHDRs greater than 30% were compared (17% v 3%, p = 0.002). There was a fourfold increase in the proportion of female RVO patients with a cCHDR above 15% (40% v 9%, p <0.0001) and at a cCHDR of 30% and above (10% v 0%, p = 0.004). There were also significant differences in the cCHDR between central and branch RVO (both sexes). The branch form of RVO (BRVO) having higher cCHDRs because of systolic hypertension (164.1 (21.6) mm Hg v 149.5 (23.5) mm Hg, p = 0.003) and age (61.7 (8.3) years v 56.7 (10.6) years, p = 0.017).
CONCLUSIONS
RVO is the presenting complaint in a group of patients at increased risk of CVD and is in agreement with the long term follow up data demonstrating an increased mortality from CVD in patients with RVO. The Framingham algorithm can accurately determine the cCHDR (or cCVDR) to assist the clinician in deciding who to treat in accordance with the Joint British Societies' guidelines, with particular regard to hypertension, lipid lowering, and the use of aspirin therapy.
目的
视网膜静脉阻塞（RVO）患者患心血管疾病（CVD）的风险增加。使用弗雷明汉算法确定未来患CVD的风险，并将该风险估计值用于指导RVO患者CVD预防性治疗的决策。
方法
对107例未经挑选的RVO患者进行研究。在排除因年龄、数据缺失或既往存在心血管疾病的18例患者后，计算其余89例患者的计算性冠心病风险（cCHDR）和计算性心血管疾病风险（cCVDR），并通过t检验或卡方检验将其与标准化风险以及英国公布的冠心病发病率进行比较。
结果
所有RVO患者的平均10年cCVDR显著高于弗雷明汉标准化风险（20.6%（1.2%）对15.7%（1.1%），p = 0.009），女性RVO患者尤其如此（17.8%（1.2%）对12.7%（1.0%），p = 0.022）。与英国30至74岁之间冠心病的实际发病率相比，10年cCHDR在男性中超过预期的两倍（62%对28%，p <0.0001）。当比较大于30%的cCHDR时，这一比例上升至近六倍（17%对3%，p = 0.002）。cCHDR高于15%的女性RVO患者比例增加了四倍（40%对9%，p <0.0001），在cCHDR为30%及以上时（10%对0%，p = 0.004）也是如此。中心性和分支性RVO（男女均有）之间的cCHDR也存在显著差异。分支性RVO（BRVO）由于收缩期高血压（164.1（21.6）mmHg对149.5（23.5）mmHg，p = 0.003）和年龄（61.7（8.3）岁对56.7（10.6）岁，p = 0.017）而具有更高的cCHDR。
结论
RVO是一组CVD风险增加患者的首发症状，这与长期随访数据一致，该数据表明RVO患者CVD死亡率增加。弗雷明汉算法可以准确确定cCHDR（或cCVDR），以帮助临床医生根据英国联合学会指南决定治疗对象，特别是在高血压、降脂和使用阿司匹林治疗方面。
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