Tzoulaki Ioanna, Elliott Paul, Kontis Vasilis, Ezzati Majid
From Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, Greece (IT); MRC-PHE Centre for Environment and Health, Imperial College London, London, UK (I.T., P.E., V.K., M.E.); School of Public Health, Imperial College London, London, UK (I.T., P.E., V.K., M.E.); Imperial College Wellcome Trust Centre for Global Health Research, London, UK (P.E., M.E.); and WHO Collaborating Centre on NCD Surveillance and Epidemiology, London, UK (P.E., M.E.).
Circulation. 2016 Jun 7;133(23):2314-33. doi: 10.1161/CIRCULATIONAHA.115.008718.
Information on exposure to, and health effects of, cardiovascular disease (CVD) risk factors is needed to develop effective strategies to prevent CVD events and deaths. Here, we provide an overview of the data and evidence on worldwide exposures to CVD risk factors and the associated health effects. Global comparative risk assessment studies have estimated that hundreds of thousands or millions of CVD deaths are attributable to established CVD risk factors (high blood pressure and serum cholesterol, smoking, and high blood glucose), high body mass index, harmful alcohol use, some dietary and environmental exposures, and physical inactivity. The established risk factors plus body mass index are collectively responsible for ≈9.7 million annual CVD deaths, with high blood pressure accounting for more CVD deaths than any other risk factor. Age-standardized CVD death rates attributable to established risk factors plus high body mass index are lowest in high-income countries, followed by Latin America and the Caribbean; they are highest in the region of central and eastern Europe and central Asia. However, estimates of the health effects of CVD risk factors are highly uncertain because there are insufficient population-based data on exposure to most CVD risk factors and because the magnitudes of their effects on CVDs in observational studies are likely to be biased. We identify directions for research and surveillance to better estimate the effects of CVD risk factors and policy options for reducing CVD burden by modifying preventable risk factors.
为制定预防心血管疾病(CVD)事件和死亡的有效策略,需要有关CVD风险因素暴露情况及其对健康影响的信息。在此,我们概述了全球范围内CVD风险因素暴露情况及相关健康影响的数据和证据。全球比较风险评估研究估计,数十万或数百万例CVD死亡可归因于已确定的CVD风险因素(高血压、血清胆固醇、吸烟和高血糖)、高体重指数、有害饮酒、一些饮食和环境暴露以及身体活动不足。已确定的风险因素加上体重指数每年共同导致约970万例CVD死亡,其中高血压导致的CVD死亡比任何其他风险因素都多。归因于已确定风险因素加上高体重指数的年龄标准化CVD死亡率在高收入国家最低,其次是拉丁美洲和加勒比地区;在中欧和东欧以及中亚地区最高。然而,由于缺乏基于人群的大多数CVD风险因素暴露数据,且观察性研究中它们对CVD的影响程度可能存在偏差,因此对CVD风险因素健康影响的估计存在很大不确定性。我们确定了研究和监测方向,以更好地估计CVD风险因素的影响,以及通过改变可预防风险因素来减轻CVD负担的政策选择。