Dunlay Shannon M, Weston Susan A, Jacobsen Steven J, Roger Véronique L
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Am J Med. 2009 Nov;122(11):1023-8. doi: 10.1016/j.amjmed.2009.04.022.
The relative contribution of risk factors to the development of heart failure remains controversial. Further, whether these contributions have changed over time or differ by sex is unclear. Few population-based studies have been performed. We aimed to estimate the population attributable risk (PAR) associated with key risk factors for heart failure in the community.
Between 1979 and 2002, 962 incident heart failure cases in Olmsted County were age and sex-matched to population-based controls using Rochester Epidemiology Project resources. We determined the frequency of risk factors (coronary heart disease, hypertension, diabetes mellitus, obesity, and smoking), odds ratios, and PAR of each risk factor for heart failure.
The mean number of risk factors for heart failure per case was 1.9 + or - 1.1 and increased over time (P<.001). Hypertension was the most common (66%), followed by smoking (51%). The prevalence of hypertension, obesity, and smoking increased over time. The risk of heart failure was particularly high for coronary disease and diabetes with odds ratios (95% confidence intervals) of 3.05 (2.36-3.95) and 2.65 (1.98-3.54), respectively. However, the PAR was highest for coronary disease and hypertension; each accounted for 20% of heart failure cases in the population, although coronary disease accounted for the greatest proportion of cases in men (PAR 23%) and hypertension was of greatest importance in women (PAR 28%).
Preventing coronary disease and hypertension will have the greatest population impact in preventing heart failure. Sex-targeted prevention strategies might confer additional benefit. However, these relationships can change, underscoring the importance of continued surveillance of heart failure.
风险因素对心力衰竭发生发展的相对贡献仍存在争议。此外，这些贡献是否随时间变化或存在性别差异尚不清楚。基于人群的研究较少。我们旨在估计社区中与心力衰竭关键风险因素相关的人群归因风险（PAR）。
1979年至2002年间，利用罗切斯特流行病学项目资源，对奥尔姆斯特德县962例新发心力衰竭病例按年龄和性别与基于人群的对照进行匹配。我们确定了风险因素（冠心病、高血压、糖尿病、肥胖和吸烟）的频率、比值比以及各风险因素导致心力衰竭的PAR。
每例心力衰竭患者的风险因素平均数为1.9±1.1，且随时间增加（P<0.001）。高血压最为常见（66%），其次是吸烟（51%）。高血压、肥胖和吸烟的患病率随时间增加。冠心病和糖尿病导致心力衰竭的风险特别高，比值比（95%置信区间）分别为3.05（2.36 - 3.95）和2.65（1.98 - 3.54）。然而，冠心病和高血压的PAR最高；在人群中，二者各占心力衰竭病例的20%，尽管冠心病在男性病例中占比最大（PAR 23%），而高血压在女性中最为重要（PAR 28%）。
预防冠心病和高血压对预防心力衰竭将产生最大的人群影响。针对性别的预防策略可能带来额外益处。然而，这些关系可能会发生变化，这凸显了持续监测心力衰竭的重要性。
