Department of Public Health and Caring Sciences, Uppsala University, Sweden.
Department of Public Health, University of Turku, Turku University Hospital, Turku, Finland.
Int J Cardiol. 2018 Oct 15;269:7-12. doi: 10.1016/j.ijcard.2018.07.005. Epub 2018 Jul 5.
Few studies have examined long-term associations of unfavorable and favorable changes in vascular risk factors with incident coronary heart disease (CHD). We examined this issue in a middle-aged disease-free population.
We used repeat data from the Whitehall II cohort study. Five biomedical, behavioral and psychosocial examinations of 8335 participants without CHD produced up to 20,357 person-observations to mimic a non-randomized pseudo-trial. After measurement of potential change in 6 risk factors twice (total cholesterol, blood pressure, smoking, overweight, psychological distress, problems in social relationships), a 5-year follow-up of CHD was undertaken.
Incidence of CHD was 7.4/1000 person-years. Increases from normal to high cholesterol (hazard ratio, HR = 1.59, 95% CI 1.26-2.00) and from normal to high blood pressure (HR = 1.64, 95% CI 1.33-2.03), as compared to remaining at the normal level, were associated with increased risk of CHD. In contrast, decreases from high to low levels of cholesterol (HR = 0.73, 95% CI 0.58-0.91), psychological distress (HR = 0.68, 95% CI 0.51-0.90), and problems in social relationships (HR = 0.65, 95% CI 0.50-0.85), and quitting smoking (HR = 0.49, 95% CI 0.29-0.82) were associated with a reduced CHD risk compared to remaining at high risk factor levels. The highest absolute risk was associated with persistent exposure to both high cholesterol and hypertension (incidence 18.1/1000 person-years) and smoking and overweight (incidence 17.7/1000 person-years).
While persistent exposures and changes in biological and behavioral risk factors relate to the greatest increases and reductions in 5-year risk of CHD, also favorable changes in psychosocial risk factors appear to reduce CHD risk.
很少有研究探讨血管危险因素的不利和有利变化与冠心病（CHD）发病之间的长期关联。我们在一个中年无疾病人群中研究了这个问题。
我们使用了 Whitehall II 队列研究的重复数据。8335 名无 CHD 参与者进行了 5 次生物医学、行为和心理社会检查，产生了多达 20357 次个体观察，以模拟非随机伪试验。在两次测量 6 种危险因素（总胆固醇、血压、吸烟、超重、心理困扰、社会关系问题）的潜在变化后，进行了为期 5 年的 CHD 随访。
CHD 的发病率为 7.4/1000 人年。与保持在正常水平相比，胆固醇从正常水平升高到高水平（危险比[HR] = 1.59，95%置信区间[CI] 1.26-2.00）和血压从正常水平升高到高水平（HR = 1.64，95%CI 1.33-2.03）与 CHD 风险增加相关。相比之下，胆固醇从高水平降至低水平（HR = 0.73，95%CI 0.58-0.91）、心理困扰（HR = 0.68，95%CI 0.51-0.90）、社会关系问题（HR = 0.65，95%CI 0.50-0.85）和戒烟（HR = 0.49，95%CI 0.29-0.82）与保持高危险因素水平相比，CHD 风险降低相关。持续暴露于高胆固醇和高血压（发病率 18.1/1000 人年）以及吸烟和超重（发病率 17.7/1000 人年）与 5 年 CHD 风险的最大绝对风险相关。
虽然生物和行为危险因素的持续暴露和变化与 5 年 CHD 风险的最大增加和降低有关，但心理社会危险因素的有利变化似乎也降低了 CHD 风险。
