Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, United Kingdom
The George Institute for Global Health, University of Oxford, United Kingdom.
J Am Heart Assoc. 2017 Sep 18;6(9):e005967. doi: 10.1161/JAHA.117.005967.
Coronary heart disease and peripheral arterial disease (PAD) affect different vascular territories. Supplementing baseline findings with assays from stored serum, we compared their 20-year predictors.
We randomly recruited 15 737 disease-free men and women aged 30 to 75 years across Scotland between 1984 and 1995 and followed them through 2009 for death and hospital diagnoses. Of these, 3098 developed coronary heart disease (19.7%), and 499 PAD (3.2%). Hazard ratios for 45 variables in the Cox model were adjusted for age and sex and for factors in the 2007 ASSIGN cardiovascular risk score. Forty-four of them were entered into parsimonious predictive models, tested by c-statistics and net reclassification improvements. Many hazard ratios diminished with adjustment and parsimonious modeling, leaving significant survivors. The hazard ratios were mostly higher in PAD. New parsimonious models increased the c-statistic and net reclassification improvements over ASSIGN variables alone but varied in their components and ranking. Coronary heart disease and PAD shared 7 of the 9 factors from ASSIGN: age, sex, family history, socioeconomic status, diabetes mellitus, tobacco smoking, and systolic blood pressure (but neither total nor high-density lipoprotein cholesterol); plus 4 new ones: NT-pro-BNP, cotinine, high-sensitivity C-reactive protein, and cystatin-C. The highest ranked hazard ratios for continuous factors in coronary heart disease were those for age, total cholesterol, high-sensitivity troponin, NT-pro-BNP, cotinine, apolipoprotein A, and waist circumference (plus 10 more); in PAD they were age, high-sensitivity C-reactive protein, systolic blood pressure, expired carbon monoxide, cotinine, socioeconomic status, and lipoprotein (a) (plus 5 more).
The mixture of shared with disparate determinants for arterial disease in the heart and the legs implies nonidentical pathogenesis: cholesterol dominant in the former, and inflammation (high-sensitivity C-reactive protein, diabetes mellitus, smoking) in the latter.
冠心病和外周动脉疾病（PAD）影响不同的血管区域。本研究通过补充基线检测结果，比较了它们 20 年的预测指标。
本研究在 1984 年至 1995 年期间，随机招募了年龄在 30 至 75 岁之间的、无疾病的 15737 名苏格兰男性和女性，并在 2009 年之前对其进行死亡和住院诊断随访。其中，3098 人患有冠心病（19.7%），499 人患有 PAD（3.2%）。Cox 模型中的 45 个变量的风险比通过年龄和性别以及 2007 年 ASSIGN 心血管风险评分中的因素进行调整。其中 44 个变量被纳入简约预测模型，通过 C 统计量和净重新分类改善来进行测试。许多风险比在调整和简约建模后减小，留下了显著的幸存者。PAD 中的风险比大多更高。新的简约模型增加了 C 统计量和净重新分类改善，优于 ASSIGN 变量，但在组成和排名上存在差异。冠心病和 PAD 与 ASSIGN 中的 9 个因素中有 7 个相同：年龄、性别、家族史、社会经济地位、糖尿病、吸烟和收缩压（但既不是总胆固醇也不是高密度脂蛋白胆固醇）；再加上 4 个新的因素：NT-pro-BNP、可替宁、高敏 C 反应蛋白和胱抑素 C。冠心病中连续变量的最高风险比为年龄、总胆固醇、高敏肌钙蛋白、NT-pro-BNP、可替宁、载脂蛋白 A 和腰围（再加上另外 10 个）；PAD 中则为年龄、高敏 C 反应蛋白、收缩压、呼出一氧化碳、可替宁、社会经济地位和脂蛋白（a）（再加上另外 5 个）。
心脏和腿部动脉疾病的共同决定因素与不同决定因素表明其发病机制不同：前者以胆固醇为主，后者以炎症（高敏 C 反应蛋白、糖尿病、吸烟）为主。
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