Woodward M, Huxley H, Lam T H, Barzi F, Lawes C M M, Ueshima H
The George Institute for International Health, The University of Sydney, NSW, Australia.
Eur J Cardiovasc Prev Rehabil. 2005 Oct;12(5):484-91. doi: 10.1097/01.hjr.0000170264.84820.8e.
Cardiovascular disease is already the leading cause of death in many Asian populations. Relationships between vascular risk factors and cardiovascular disease may differ in Asian and western populations. Previously, a lack of prospective data has prevented the reliable quantification of such differences, which, if they were shown to exist, would suggest that novel cardiovascular prevention and treatment strategies are required for Asia.
An individual participant data meta-analysis of 32 studies from the Asia-Pacific region involving 331 100 subjects (75% from Asia; 25% from the predominantly Caucasian populations of Australia and New Zealand).
Outcomes were death from coronary heart disease, ischaemic and haemorrhagic stroke. Hazard ratios were estimated from Cox models for systolic blood pressure (SBP), total cholesterol, triglycerides, body mass index, diabetes and current cigarette smoking, stratified by study and sex and adjusted for age, the other risk factors and regression dilution.
After an average period of follow-up of 4 years there were 2082 deaths from coronary heart disease, 600 from haemorrhagic stroke and 420 from ischaemic stroke. The direction and strength of the associations between risk factors and cardiovascular outcomes were similar in the two regions, although in two cases there were significant differences. Triglycerides were more strongly associated with coronary heart disease in Australia and New Zealand (P = 0.03), whereas SBP showed a stronger relationship with haemorrhagic stroke in Asia (P = 0.04).
Classical vascular risk factors act similarly in Asian and Caucasian populations; prevention and treatment strategies should thus be similar. Blood pressure reduction should be particularly effective in Asia.
心血管疾病已成为许多亚洲人群的主要死因。血管危险因素与心血管疾病之间的关系在亚洲和西方人群中可能有所不同。此前，缺乏前瞻性数据阻碍了对此类差异进行可靠量化，而如果这些差异确实存在，将表明亚洲需要新的心血管疾病预防和治疗策略。
对亚太地区32项研究的个体参与者数据进行荟萃分析，涉及331100名受试者（75%来自亚洲；25%来自澳大利亚和新西兰以白种人为主的人群）。
结局指标为冠心病死亡、缺血性和出血性卒中。通过Cox模型估计收缩压（SBP）、总胆固醇、甘油三酯、体重指数、糖尿病和当前吸烟情况的风险比，按研究和性别分层，并对年龄、其他危险因素和回归稀释进行调整。
平均随访4年后，有2082例冠心病死亡、600例出血性卒中死亡和420例缺血性卒中死亡。尽管在两个案例中有显著差异，但两个地区危险因素与心血管结局之间关联的方向和强度相似。在澳大利亚和新西兰，甘油三酯与冠心病的关联更强（P = 0.03），而在亚洲，收缩压与出血性卒中的关系更强（P = 0.04）。
经典的血管危险因素在亚洲和白种人群体中的作用相似；因此，预防和治疗策略也应相似。在亚洲，降低血压可能特别有效。
