Cairns Benjamin J, Balkwill Angela, Canoy Dexter, Green Jane, Reeves Gillian K, Beral Valerie
Cancer Epidemiology Unit, University of Oxford, Oxford, UK
Cancer Epidemiology Unit, University of Oxford, Oxford, UK.
Eur J Prev Cardiol. 2015 Dec;22(12):1626-34. doi: 10.1177/2047487314563710. Epub 2014 Dec 15.
Vascular disease mortality has declined rapidly in most Western countries, against a background of improved treatments and falling prevalence of smoking, but rising obesity. We examined whether this decline differed by lifestyle risk factors for vascular disease.
During 2001-2010, there were 9241 vascular disease deaths in a prospective study of 1.3 million women in middle age, about one-quarter of all UK women in the eligible age range (50-64 years in 1996-2001). We estimated percentage declines in mortality from coronary heart disease, cerebrovascular disease and other vascular diseases, overall and by age, smoking, alcohol consumption, adiposity, physical activity, socioeconomic status and age at leaving school. Over 10 years, coronary heart disease mortality fell by half (52%), cerebrovascular disease mortality by two-fifths (42%) and other vascular disease mortality by one-fifth (22%). Lean women experienced greater declines in coronary heart disease mortality than overweight or obese women (70%, 48% and 26%, respectively; P < 0.001 for heterogeneity) and women in the highest and middle thirds of socioeconomic status experienced greater declines in other (non-coronary, non-cerebrovascular) vascular disease mortality than women in the lowest third (41% and 42% and -9%, respectively; P = 0.001). After accounting for multiple testing, there were no other significant differences in vascular mortality trends by any lifestyle risk factor, including by smoking status.
Vascular disease mortality trends varied in this cohort by adiposity and socioeconomic status, but not by smoking status or other lifestyle risk factors. Prevention and treatment of vascular disease appear not to have been equally effective in all subgroups of UK women.
在治疗手段改善、吸烟率下降但肥胖率上升的背景下，多数西方国家的血管疾病死亡率迅速下降。我们研究了这种下降在血管疾病的生活方式风险因素方面是否存在差异。
在2001年至2010年期间，对130万中年女性进行的前瞻性研究中有9241例血管疾病死亡病例，约占英国所有符合年龄范围（1996 - 2001年为50 - 64岁）女性的四分之一。我们估计了冠心病、脑血管疾病和其他血管疾病死亡率的下降百分比，总体以及按年龄、吸烟、饮酒、肥胖、身体活动、社会经济地位和离校年龄进行了分析。在10年期间，冠心病死亡率下降了一半（52%），脑血管疾病死亡率下降了五分之二（42%），其他血管疾病死亡率下降了五分之一（22%）。瘦女性的冠心病死亡率下降幅度大于超重或肥胖女性（分别为70%、48%和26%；异质性P < 0.001），社会经济地位处于最高和中间三分之一的女性在其他（非冠心病、非脑血管）血管疾病死亡率方面的下降幅度大于处于最低三分之一的女性（分别为41%、42%和 - 9%；P = 0.001）。在考虑多重检验后，按任何生活方式风险因素（包括吸烟状况）划分的血管死亡率趋势均无其他显著差异。
该队列中血管疾病死亡率趋势因肥胖和社会经济地位而异，但不因吸烟状况或其他生活方式风险因素而异。在英国女性所有亚组中，血管疾病的预防和治疗似乎并非同样有效。
