Greenland Philip, Knoll Maria Deloria, Stamler Jeremiah, Neaton James D, Dyer Alan R, Garside Daniel B, Wilson Peter W
Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill, USA.
JAMA. 2003 Aug 20;290(7):891-7. doi: 10.1001/jama.290.7.891.
A frequently cited concept is that individual major risk factors for coronary heart disease (CHD) are absent in many patients (perhaps >50%) with CHD. However, prior studies have not systematically evaluated the extent to which CHD patients have previous exposure to at least 1 risk factor, including diabetes, cigarette smoking, or clinically elevated levels of cholesterol or blood pressure.
To determine the frequency of exposure to major CHD risk factors.
DESIGN, SETTING, AND PARTICIPANTS: Three prospective cohort studies were included: the Chicago Heart Association Detection Project in Industry, with a population sample of 35 642 employed men and women aged 18 to 59 years; screenees for the Multiple Risk Factor Intervention Trial, including 347 978 men aged 35 to 57 years; and a population-based sample of 3295 men and women aged 34 to 59 years from the Framingham Heart Study (FHS). Follow-up lasted 21 to 30 years across the studies.
Fatal CHD in all cohorts and nonfatal myocardial infarction (MI) in the FHS, compared by exposure to major CHD risk factors, defined as total cholesterol of at least 240 mg/dL (> or =6.22 mmol/L), systolic blood pressure of at least 140 mm Hg, diastolic blood pressure of at least 90 mm Hg, cigarette smoking, and diabetes. Participants were stratified by sex and age (18-39 vs 40-59 years).
For fatal CHD (n = 20 995), exposure to at least 1 clinically elevated major risk factor ranged from 87% to 100%. Among those aged 40 to 59 years at baseline with fatal CHD (n = 19 263), exposure to at least 1 major risk factor ranged from 87% to 94%. For nonfatal MI, prior exposure was documented in 92% (95% CI, 87%-96%) (n = 167) of men aged 40 to 59 years at baseline and in 87% (95% CI, 80%-94%) (n = 94) of women in this age group.
Antecedent major CHD risk factor exposures were very common among those who developed CHD, emphasizing the importance of considering all major risk factors in determining CHD risk estimation and in attempting to prevent clinical CHD. These results challenge claims that CHD events commonly occur in persons without exposure to at least 1 major CHD risk factor.
一个经常被引用的概念是，许多冠心病（CHD）患者（可能超过50%）不存在个体主要危险因素。然而，先前的研究并未系统评估冠心病患者既往接触至少一种危险因素的程度，这些危险因素包括糖尿病、吸烟，或胆固醇或血压的临床水平升高。
确定接触主要冠心病危险因素的频率。
设计、设置和参与者：纳入三项前瞻性队列研究：芝加哥心脏协会工业检测项目，有35642名年龄在18至59岁的在职男性和女性作为人群样本；多重危险因素干预试验的筛查对象，包括347978名年龄在35至57岁的男性；以及弗雷明汉心脏研究（FHS）中3295名年龄在34至59岁的基于人群的样本。这些研究的随访持续了21至30年。
所有队列中的致命性冠心病以及FHS中的非致命性心肌梗死（MI），根据是否接触主要冠心病危险因素进行比较，主要冠心病危险因素定义为总胆固醇至少240mg/dL（≥6.22mmol/L）、收缩压至少140mmHg、舒张压至少90mmHg、吸烟和糖尿病。参与者按性别和年龄（18 - 39岁与40 - 59岁）分层。
对于致命性冠心病（n = 20995），接触至少一种临床水平升高的主要危险因素的比例在87%至100%之间。在基线时年龄为40至59岁的致命性冠心病患者（n = 19263）中，接触至少一种主要危险因素的比例在87%至94%之间。对于非致命性心肌梗死，在基线时年龄为40至59岁的男性中，92%（95%CI，87% - 96%）（n = 167）有既往接触记录，在该年龄组的女性中这一比例为87%（95%CI，80% - 94%）（n = 94）。
在发生冠心病的人群中，先前接触主要冠心病危险因素的情况非常普遍，这强调了在确定冠心病风险评估以及试图预防临床冠心病时考虑所有主要危险因素的重要性。这些结果对冠心病事件通常发生在未接触至少一种主要冠心病危险因素的人群这一说法提出了挑战。
