University of Texas Southwestern Medical Center, Department of Medicine, Division of Cardiology, Dallas, USA.
N Engl J Med. 2012 Jan 26;366(4):321-9. doi: 10.1056/NEJMoa1012848.
The lifetime risks of cardiovascular disease have not been reported across the age spectrum in black adults and white adults.
We conducted a meta-analysis at the individual level using data from 18 cohort studies involving a total of 257,384 black men and women and white men and women whose risk factors for cardiovascular disease were measured at the ages of 45, 55, 65, and 75 years. Blood pressure, cholesterol level, smoking status, and diabetes status were used to stratify participants according to risk factors into five mutually exclusive categories. The remaining lifetime risks of cardiovascular events were estimated for participants in each category at each age, with death free of cardiovascular disease treated as a competing event.
We observed marked differences in the lifetime risks of cardiovascular disease across risk-factor strata. Among participants who were 55 years of age, those with an optimal risk-factor profile (total cholesterol level, <180 mg per deciliter [4.7 mmol per liter]; blood pressure, <120 mm Hg systolic and 80 mm Hg diastolic; nonsmoking status; and nondiabetic status) had substantially lower risks of death from cardiovascular disease through the age of 80 years than participants with two or more major risk factors (4.7% vs. 29.6% among men, 6.4% vs. 20.5% among women). Those with an optimal risk-factor profile also had lower lifetime risks of fatal coronary heart disease or nonfatal myocardial infarction (3.6% vs. 37.5% among men, <1% vs. 18.3% among women) and fatal or nonfatal stroke (2.3% vs. 8.3% among men, 5.3% vs. 10.7% among women). Similar trends within risk-factor strata were observed among blacks and whites and across diverse birth cohorts.
Differences in risk-factor burden translate into marked differences in the lifetime risk of cardiovascular disease, and these differences are consistent across race and birth cohorts. (Funded by the National Heart, Lung, and Blood Institute.).
心血管疾病的终生风险在黑人和白人成年人的整个年龄范围内尚未得到报道。
我们在个体水平上进行了荟萃分析，使用了来自 18 项队列研究的数据，这些研究共纳入了 257384 名黑人和白人男性和女性，他们的心血管疾病危险因素在 45、55、65 和 75 岁时进行了测量。血压、胆固醇水平、吸烟状况和糖尿病状况用于根据危险因素将参与者分层为五个互斥类别。对于每个类别中的每个年龄的参与者，估计了心血管事件的剩余终生风险，将无心血管疾病死亡视为竞争事件。
我们观察到不同风险因素分层之间心血管疾病终生风险存在显著差异。在 55 岁的参与者中，那些具有最佳风险因素特征（总胆固醇水平，<180mg/分升[4.7mmol/升]；血压，收缩压<120mmHg，舒张压<80mmHg；非吸烟状态；非糖尿病状态）的参与者，在 80 岁之前死于心血管疾病的风险显著低于具有两个或更多主要风险因素的参与者（男性为 4.7%比 29.6%，女性为 6.4%比 20.5%）。那些具有最佳风险因素特征的参与者也具有较低的致死性冠心病或非致死性心肌梗死的终生风险（男性为 3.6%比 37.5%，女性为<1%比 18.3%）和致死性或非致死性卒中的终生风险（男性为 2.3%比 8.3%，女性为 5.3%比 10.7%）。在黑人、白人以及不同出生队列中，在风险因素分层内观察到类似的趋势。
风险因素负担的差异转化为心血管疾病终生风险的显著差异，并且这些差异在种族和出生队列中是一致的。（由美国国家心肺血液研究所资助）。
