Terrence Donnelly Heart Centre, St Michael's Hospital, Toronto, Ontario, Canada, University of Toronto, Toronto, Ontario, Canada.
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
J Am Coll Cardiol. 2017 Mar 28;69(12):1523-1532. doi: 10.1016/j.jacc.2017.01.025.
Few longitudinal studies have delineated the association between traditional cardiovascular risk factors and development of aortic stenosis (AS).
The authors examined the association between traditional cardiovascular risk factors and incident severe AS in a large, unselected elderly population.
This observational cohort study used multiple linked health care population-based databases of individuals older than 65 years on April 1, 2002, without prior valvular disease, coronary artery disease, heart failure, cardiac arrhythmia, cerebrovascular disease, congenital heart disease, or admissions with cardiac symptoms. The relationship between hypertension (HTN), diabetes, dyslipidemia, and incident severe AS requiring hospitalization or surgical or interventional treatment was examined.
Among 1.12 million individuals followed for a median of 13 years, 20,995 subjects developed severe AS. Overall absolute incidence was 144 per 100,000 person-years (169 and 127 per 100,000 person-years in men and women, respectively). In cause-specific hazard models, HTN (adjusted hazard ratio [HR]: 1.71; 95% confidence interval [CI]: 1.66 to 1.76), diabetes (HR: 1.49; 95% CI: 1.44 to 1.54), and dyslipidemia (HR: 1.17; 95% CI: 1.14 to 1.21) were all significantly associated with increased risk of developing severe AS (all p < 0.001). There was a positive dose-response relationship between the number and duration of cardiac risk factors and risk of AS. In the Fine-Gray model, all 3 risk factors were independently associated with a higher incidence of AS. The population-attributable risk of AS associated with 3 cardiac risk factors was 34.4% (95% CI: 32.8 to 36.0).
HTN, diabetes, and dyslipidemia have independent and dose-response associations with incident AS in an unselected population of older individuals, and together accounted for approximately one-third of the incidence of severe AS.
很少有纵向研究阐明了传统心血管危险因素与主动脉瓣狭窄（AS）发展之间的关系。
作者在一个大型的、未经选择的老年人群中研究了传统心血管危险因素与新发重度 AS 之间的关系。
这项观察性队列研究使用了多个基于人群的健康护理相关数据库，纳入了 2002 年 4 月 1 日年龄大于 65 岁、无先前瓣膜疾病、冠心病、心力衰竭、心律失常、脑血管疾病、先天性心脏病或因心脏症状住院的个体。研究了高血压（HTN）、糖尿病、血脂异常与需要住院或手术或介入治疗的新发重度 AS 之间的关系。
在中位随访 13 年期间，112 万人中有 20995 人发生了重度 AS。总体绝对发病率为 144/100000 人年（男性为 169/100000 人年，女性为 127/100000 人年）。在特定病因的危险比模型中，HTN（调整后的危险比 [HR]：1.71；95%置信区间 [CI]：1.66 至 1.76）、糖尿病（HR：1.49；95%CI：1.44 至 1.54）和血脂异常（HR：1.17；95%CI：1.14 至 1.21）均与发生重度 AS 的风险增加显著相关（均 P<0.001）。心脏危险因素的数量和持续时间与 AS 风险之间存在正剂量反应关系。在 Fine-Gray 模型中，所有 3 种危险因素均与 AS 发生率的增加独立相关。与 3 种心脏危险因素相关的 AS 人群归因风险为 34.4%（95%CI：32.8 至 36.0）。
在未选择的老年人群中，HTN、糖尿病和血脂异常与新发 AS 独立且呈剂量反应关系，共同导致约三分之一的重度 AS 发病。
