Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK Medical Research Council Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK
Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK.
BMJ. 2014 Jul 8;349:g4227. doi: 10.1136/bmj.g4227.
To assess the association between leucocyte telomere length and risk of cardiovascular disease.
Systematic review and meta-analysis.
Studies published up to March 2014 identified through searches of Medline, Web of Science, and Embase.
Prospective and retrospective studies that reported on associations between leucocyte telomere length and coronary heart disease (defined as non-fatal myocardial infarction, coronary heart disease death, or coronary revascularisation) or cerebrovascular disease (defined as non-fatal stroke or death from cerebrovascular disease) and were broadly representative of general populations--that is, they did not select cohort or control participants on the basis of pre-existing cardiovascular disease or diabetes.
Twenty four studies involving 43,725 participants and 8400 patients with cardiovascular disease (5566 with coronary heart disease and 2834 with cerebrovascular disease) were found to be eligible. In a comparison of the shortest versus longest third of leucocyte telomere length, the pooled relative risk for coronary heart disease was 1.54 (95% confidence interval 1.30 to 1.83) in all studies, 1.40 (1.15 to 1.70) in prospective studies, and 1.80 (1.32 to 2.44) in retrospective studies. Heterogeneity between studies was moderate (I(2) = 64%, 41% to 77%, Phet<0.001) and was not significantly explained by mean age of participants (P = 0.23), the proportion of male participants (P = 0.45), or distinction between retrospective versus prospective studies (P = 0.32). Findings for coronary heart disease were similar in meta-analyses restricted to studies that adjusted for conventional vascular risk factors (relative risk 1.42, 95% confidence interval 1.17 to 1.73); studies with ≥ 200 cases (1.44, 1.20 to 1.74); studies with a high quality score (1.53, 1.22 to 1.92); and in analyses that corrected for publication bias (1.34, 1.12 to 1.60). The pooled relative risk for cerebrovascular disease was 1.42 (1.11 to 1.81), with no significant heterogeneity between studies (I(2) = 41%, 0% to 72%, Phet = 0.08). Shorter telomeres were not significantly associated with cerebrovascular disease risk in prospective studies (1.14, 0.85 to 1.54) or in studies with a high quality score (1.21, 0.83 to 1.76).
Available observational data show an inverse association between leucocyte telomere length and risk of coronary heart disease independent of conventional vascular risk factors. The association with cerebrovascular disease is less certain.
评估白细胞端粒长度与心血管疾病风险之间的关联。
系统评价和荟萃分析。
截至 2014 年 3 月通过 Medline、Web of Science 和 Embase 检索到的已发表研究。
前瞻性和回顾性研究，报告白细胞端粒长度与冠心病（定义为非致命性心肌梗死、冠心病死亡或冠状动脉血运重建）或脑血管疾病（定义为非致命性中风或脑血管疾病死亡）之间的关联，且广泛代表一般人群，即他们没有根据预先存在的心血管疾病或糖尿病选择队列或对照参与者。
发现 24 项涉及 43725 名参与者和 8400 例心血管疾病患者（5566 例冠心病和 2834 例脑血管疾病）的研究符合条件。在比较白细胞端粒长度最短和最长三分之一的情况下，所有研究的冠心病合并相对危险度为 1.54（95%置信区间 1.30 至 1.83），前瞻性研究为 1.40（1.15 至 1.70），回顾性研究为 1.80（1.32 至 2.44）。研究之间的异质性为中度（I²=64%，41%至 77%，Phet<0.001），且不能用参与者的平均年龄（P=0.23）、男性参与者的比例（P=0.45）或回顾性与前瞻性研究之间的差异（P=0.32）来显著解释。在限定于调整了常规血管危险因素的研究（相对危险度 1.42，95%置信区间 1.17 至 1.73）、≥200 例病例的研究（1.44，1.20 至 1.74）、高质量评分研究（1.53，1.22 至 1.92）以及校正了发表偏倚的分析中（1.34，1.12 至 1.60），冠心病的合并相对危险度相似。脑血管疾病的合并相对危险度为 1.42（1.11 至 1.81），研究之间无显著异质性（I²=41%，0%至 72%，Phet=0.08）。前瞻性研究（1.14，0.85 至 1.54）或高质量评分研究（1.21，0.83 至 1.76）中，较短的端粒与脑血管疾病风险之间无显著关联。
现有观察性数据显示，白细胞端粒长度与冠心病风险之间存在反比关联，独立于常规血管危险因素。与脑血管疾病的关联则不太确定。
