Departments of Epidemiology & Medicine and Lipid Research Clinic, University of Iowa, 200 Hawkins Drive, SE 223 GH, Iowa City, IA 52242, USA.
J Clin Lipidol. 2012 Jan-Feb;6(1):58-65. doi: 10.1016/j.jacl.2011.10.019. Epub 2011 Nov 7.
Most incident cardiovascular disease (CVD) occurs after patients reach the age of 65. The additive benefits of aggressive risk factor management with advancing age are not well established.
To evaluate the relationship between control of four modifiable risk factors (smoking, non-high density lipoprotein cholesterol, blood pressure, and aspirin use) and risk of CVD in a primary prevention population of older men.
U.S. male physicians from the Physicians' Health Study (n = 4182; an epidemiologic follow-up of a randomized trial of aspirin and beta-carotene) who in 1997 were ≥ 65 years, free of CVD and diabetes, and had a blood sample on file were studied. Cox proportional hazard models were adjusted for age and competing causes of death. The first of any CVD event, defined as cardiovascular death, nonfatal myocardial infarction, angina, coronary revascularization, nonfatal stroke, transient ischemic attack, carotid artery surgery, and other peripheral vascular disease surgery, was measured.
Mean follow-up was 9.3 years, mean age was 73 years, and 96% were nonsmokers. Compared with when 4 of 4 risk factors were controlled (6.0% of participants), control of 0 of 4 risk factors almost quadrupled the risk of CVD (0.4% of participants; event rate 41.2%; hazard ratio [HR] 3.83, 95% confidence interval [95% CI] 1.72-8.55); control of 1 of 4 risk factors more than doubled the risk (14.2% of participants; HR 2.53, 95% CI 1.80-3.57); control of 2 of 4 risk factors almost doubled the risk (43.8% of participants; HR 1.94, 95% CI 1.41-2.69), and those with control of 3 of 4 risk factors also were at increased risk (35.6% of participants; HR 1.80, 95% CI 1.30-2.50). Control of each additional risk factor was associated with greater cardiovascular protection (P for trend P = .002). Depending on the number of risk factors controlled, the number-needed to control to prevent one CVD event ranged from 5 to 22.
Control of 4 treatable risk factors (nonsmoking, control of non-high density lipoprotein cholesterol and blood pressure, and aspirin use) was associated with substantial protection against incident cardiovascular events in older men even after adjustment for competing causes of mortality.
大多数心血管疾病（CVD）事件发生在患者年龄超过 65 岁之后。随着年龄的增长，积极控制风险因素的额外益处尚未得到充分证实。
评估在老年男性一级预防人群中，控制四种可改变的危险因素（吸烟、非高密度脂蛋白胆固醇、血压和阿司匹林使用）与 CVD 风险之间的关系。
来自医生健康研究（Physicians' Health Study）的美国男性医生（n = 4182；对阿司匹林和β-胡萝卜素的随机试验进行流行病学随访），他们在 1997 年时年龄≥65 岁，无 CVD 和糖尿病，并且有血液样本。使用 Cox 比例风险模型调整年龄和其他死因的竞争。首次任何 CVD 事件（定义为心血管死亡、非致死性心肌梗死、心绞痛、冠状动脉血运重建、非致死性中风、短暂性脑缺血发作、颈动脉手术和其他外周血管疾病手术）被测量。
平均随访 9.3 年，平均年龄 73 岁，96%为不吸烟者。与控制 4 个风险因素中的 4 个（4%的参与者）相比，控制 4 个风险因素中的 0 个几乎使 CVD 风险增加了四倍（4%的参与者；事件发生率为 41.2%；风险比[HR]3.83，95%置信区间[95%CI]1.72-8.55）；控制 1 个风险因素增加了两倍（14.2%的参与者；HR 2.53，95% CI 1.80-3.57）；控制 2 个风险因素增加了近一倍（43.8%的参与者；HR 1.94，95% CI 1.41-2.69），控制 3 个风险因素的参与者也面临更高的风险（35.6%的参与者；HR 1.80，95% CI 1.30-2.50）。控制每个额外的风险因素与更大的心血管保护相关（趋势检验的 P 值为.002）。根据控制的风险因素数量，预防一次 CVD 事件所需的人数从 5 到 22 人不等。
即使调整了其他死因的竞争，控制 4 种可治疗的危险因素（不吸烟、控制非高密度脂蛋白胆固醇和血压、使用阿司匹林）与老年男性中发生心血管事件的显著保护相关。
