Kannel W B, Vokonas P S
Evans Memorial Department of Research and Department of Medicine, University Hospital, Boston University School of Medicine, MA.
Ann Epidemiol. 1992 Jan-Mar;2(1-2):5-14. doi: 10.1016/1047-2797(92)90031-k.
Cardiovascular disease constitutes an expanding problem in the elderly because of the increasing size of the aged population. Atherosclerosis, hypertension, and diabetes are responsible for the predonderance of cardiovascular disease, which causes 70% of all deaths beyond age 75. Coronary heart disease (CHD) is the most common and most lethal cardiovascular event in both sexes, exacting a large toll in disability and deteriorated quality of life in old age. Unrecognized myocardial infarctions are especially common and are as serious as symptomatic infarctions. beyond age 65, women are as vulnerable to cardiovascular death as men. The predisposing modifiable risk factors for coronary disease, stroke, peripheral arterial disease, and cardiac failure are similar in young and old and in men and women. These include hypertension, dyslipidemia, impaired glucose tolerance, physical indolence, and cigarette smoking. An attenuated risk ratio for some risk factors is offset by a greater incidence of cardiovascular events in advanced age so that the attributable risk and the potential benefit of treatment rise with age. Because the major risk factors predict CHD as efficiently in the elderly as in the young, and the decline in cardiovascular mortality has included the elderly, preventive efforts in the elderly may have substantial potential benefit. At advanced age, total cholesterol levels are considerably higher in women than in men. Some 10 million elderly, two-thirds of whom are women, may require investigation and treatment for elevated lipid levels, as determined by National Heart, Lung, and Blood Institute (NHLBI) guidelines. Because of the preponderance of women in the elderly population, trials of the efficacy of correcting risk factors in general, and lipids in particular, should include women.
由于老年人口规模不断扩大，心血管疾病已成为老年人中日益严重的问题。动脉粥样硬化、高血压和糖尿病是心血管疾病的主要成因，在75岁以上人群的所有死亡病例中，心血管疾病导致的死亡占70%。冠心病（CHD）是男女中最常见且最致命的心血管事件，给老年人带来了巨大的残疾负担，并使生活质量下降。未被识别的心肌梗死尤为常见，其严重性与有症状的梗死相当。65岁以上的女性与男性一样容易发生心血管死亡。冠心病、中风、外周动脉疾病和心力衰竭的可改变的易感风险因素在年轻人和老年人、男性和女性中相似。这些因素包括高血压、血脂异常、糖耐量受损、身体怠惰和吸烟。一些风险因素的风险比虽有所降低，但因高龄人群心血管事件发生率更高而被抵消，因此治疗的归因风险和潜在益处会随着年龄增长而增加。由于主要风险因素在老年人中预测冠心病的效率与年轻人相同，且心血管死亡率的下降也涵盖了老年人，因此针对老年人的预防措施可能会带来巨大的潜在益处。在高龄阶段，女性的总胆固醇水平明显高于男性。根据美国国立心肺血液研究所（NHLBI）的指南，约1000万老年人可能需要接受血脂升高的调查和治疗，其中三分之二为女性。由于老年人口中女性占多数，因此在一般风险因素纠正试验，尤其是血脂纠正试验中，应纳入女性。
