Ulmer H, Kelleher C C, Fitz-Simon N, Diem G, Concin H
Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria.
J Intern Med. 2007 Jun;261(6):566-76. doi: 10.1111/j.1365-2796.2007.01779.x.
It is well established that morbidity and mortality patterns in cardiovascular diseases vary strongly over time, yet the determinants of such trends remain poorly understood. To assess the potential contribution of secular or cross-generation patterns, we evaluated birth cohort-related trends across the 20th century of risk factors in a large database of Austrian men and women.
Trends in risk factors were investigated for 181,350 adults aged 20-79 years born between 1905 and 1975 undergoing 698,954 health examinations between 1985 and 2005 as participants of the Vorarlberg Health Monitoring and Promotion Programme.
There was clear evidence of cohort-related shifts in all risk factors. Total serum cholesterol and triglyceride declined markedly, particularly in the youngest cohorts, as did systolic and diastolic blood pressure in both men and women. By contrast, fasting glucose showed a strong rising tendency in both sexes and at all ages, most markedly in young males. Average glucose levels were between 4 and 15 mg dL(-1) higher in individuals at the same age born 20 years later. In males, body weight expressed in kg m(-2) (body mass index) was increasing as well; however, in women, patterns were most marked at the 90th percentile.
These findings provide strong evidence of population wide secular shifts and suggest that in addition to period influences, most probably through treatment intervention and lifestyle change, determinants across the life-course are programming shifts from childhood onwards.
心血管疾病的发病率和死亡率模式随时间变化很大，这一点已得到充分证实，但此类趋势的决定因素仍知之甚少。为评估长期或跨代模式的潜在影响，我们在一个包含大量奥地利男性和女性的数据库中，评估了20世纪出生队列中危险因素的相关趋势。
对1905年至1975年出生的181350名20至79岁成年人的危险因素趋势进行了调查，这些人在1985年至2005年间作为福拉尔贝格健康监测与促进项目的参与者接受了698954次健康检查。
所有危险因素均有明显的队列相关变化证据。总血清胆固醇和甘油三酯显著下降，尤其是最年轻的队列，男性和女性的收缩压和舒张压也出现了下降。相比之下，空腹血糖在所有年龄段的男性和女性中均呈现出强烈的上升趋势，在年轻男性中最为明显。20年后出生的同年龄个体的平均血糖水平高出4至15mg dL(-1)。在男性中，以kg m(-2)表示的体重（体重指数）也在增加；然而，在女性中，模式在第90百分位数最为明显。
这些发现为全人群的长期变化提供了有力证据，并表明除了可能通过治疗干预和生活方式改变产生的时期影响外，生命历程中的决定因素从儿童时期起就正在规划这种变化。
