心血管风险亚临床标志物踝臂指数在非洲农村人群中的分布：SASPI研究
Distribution of a subclinical marker of cardiovascular risk, the ankle brachial index, in a rural African population: SASPI study.
作者信息
Fowkes F Gerry R, Thorogood Margaret, Connor Myles D, Lewando-Hundt Gillian, Tzoulaki Ioanna, Tollman Stephen M
机构信息
FRCPE, Wolfson Unit for Prevention of Peripheral Vascular Diseases, University of Edinburgh, Edinburgh, UK.
出版信息
Eur J Cardiovasc Prev Rehabil. 2006 Dec;13(6):964-9. doi: 10.1097/01.hjr.0000201511.28590.9f.
BACKGROUND
In sub-Saharan Africa, hypertension and stroke are emerging as an important cause of death and disability, whereas coronary heart disease appears still to be uncommon. The aim of our study was to measure for the first time in an African population the ankle brachial index (ABI), which is known to be a good marker of subclinical atheroma and of the risk of future cardiovascular events.
METHODS
The study was part of the Southern African Stroke Prevention Initiative (SASPI). It comprised a cross-sectional survey conducted in rural north-east South Africa in the sub-district of Agincourt, in which the demography of the population has been closely monitored. A stratified sample of 10 villages were selected and within these a random sample was chosen of 526 men and women aged 35 years and older. Subjects were visited on up to three occasions to be interviewed and have a clinical examination by specially trained nurses. This included an assessment of cardiovascular risk factors and measurement of the ABI (ratio of ankle : brachial systolic pressure) using a Doppler ultrasound machine.
RESULTS
The sample comprised 322 subjects in whom the mean ABI (lower of either leg) was 1.05 in both men and women. The distribution of ABI was negatively skewed and a low ABI of 0.9 or less, indicative of significant atheroma and higher cardiovascular risk, increased with age from 3.9% in 40-49 year olds to 39.7% in those aged 70 years and older. Lower ABI was related to current cigarette smoking (P=0.02) and higher systolic and diastolic blood pressure (P<0.01, P=0.02, respectively) but not total cholesterol levels, which were relatively low in this population (mean 4.47 mmol/l).
CONCLUSION
The distribution of the ABI in this rural African population was very similar to that reported in western populations, and suggests that this population has subclinical peripheral atheroma and is at an increased risk of future cardiovascular events, thus providing further evidence of an epidemiological transition towards cardiovascular disease.
背景
在撒哈拉以南非洲地区，高血压和中风正成为死亡和残疾的重要原因，而冠心病似乎仍然不常见。我们研究的目的是首次在非洲人群中测量踝臂指数（ABI），该指数已知是亚临床动脉粥样硬化和未来心血管事件风险的良好指标。
方法
该研究是南部非洲中风预防倡议（SASPI）的一部分。它包括在南非东北部农村阿金库尔分区进行的一项横断面调查，该地区人口的人口统计学情况一直受到密切监测。从10个村庄中选取了分层样本，并在这些村庄中随机抽取了526名35岁及以上的男性和女性。受试者接受了多达三次的访问，由经过专门培训的护士进行访谈和临床检查。这包括对心血管危险因素的评估以及使用多普勒超声仪测量ABI（踝部与肱部收缩压之比）。
结果
样本包括322名受试者，男性和女性的平均ABI（双腿中较低者）均为1.05。ABI的分布呈负偏态，低ABI（0.9或更低）表明存在明显的动脉粥样硬化和更高的心血管风险，其比例随年龄增长而增加，从40 - 49岁人群中的3.9%增至70岁及以上人群中的39.7%。较低的ABI与当前吸烟（P = 0.02）以及较高的收缩压和舒张压相关（分别为P < 0.01，P = 0.02），但与总胆固醇水平无关，该人群的总胆固醇水平相对较低（平均4.47 mmol/l）。
结论
该农村非洲人群中ABI的分布与西方人群报告的情况非常相似，表明该人群存在亚临床外周动脉粥样硬化且未来心血管事件风险增加，从而为向心血管疾病的流行病学转变提供了进一步证据。
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