Division of General Medicine, Columbia University, New York, New York.
Department of Epidemiology and Biostatistics, School of Medicine, University of California-San Francisco, San Francisco, California.
J Am Coll Cardiol. 2019 Jul 23;74(3):330-341. doi: 10.1016/j.jacc.2019.03.529.
Blood pressure (BP) and cholesterol are major modifiable risk factors for cardiovascular disease (CVD), but effects of exposures during young adulthood on later life CVD risk have not been well quantified.
The authors sought to evaluate the independent associations between young adult exposures to risk factors and later life CVD risk, accounting for later life exposures.
The authors pooled data from 6 U.S. cohorts with observations spanning the life course from young adulthood to later life, and imputed risk factor trajectories for low-density lipoprotein (LDL) and high-density lipoprotein cholesterols, systolic and diastolic BP starting from age 18 years for every participant. Time-weighted average exposures to each risk factor during young (age 18 to 39 years) and later adulthood (age ≥40 years) were calculated and linked to subsequent risks of coronary heart disease (CHD), heart failure (HF), or stroke.
A total of 36,030 participants were included. During a median follow-up of 17 years, there were 4,570 CHD, 5,119 HF, and 2,862 stroke events. When young and later adult risk factors were considered jointly in the model, young adult LDL ≥100 mg/dl (compared with <100 mg/dl) was associated with a 64% increased risk for CHD, independent of later adult exposures. Similarly, young adult SBP ≥130 mm Hg (compared with <120 mm Hg) was associated with a 37% increased risk for HF, and young adult DBP ≥80 mm Hg (compared with <80 mm Hg) was associated with a 21% increased risk.
Cumulative young adult exposures to elevated systolic BP, diastolic BP and LDL were associated with increased CVD risks in later life, independent of later adult exposures.
血压（BP）和胆固醇是心血管疾病（CVD）的主要可改变危险因素，但年轻时暴露于这些因素对以后生活中 CVD 风险的影响尚未得到很好的量化。
作者试图评估年轻人接触危险因素与以后生活中 CVD 风险之间的独立关联，同时考虑以后生活中的接触情况。
作者汇总了 6 项美国队列研究的数据，这些研究的观察结果涵盖了从青年期到老年期的整个生命过程，并为每个参与者从 18 岁开始推断出 LDL 和高密度脂蛋白胆固醇、收缩压和舒张压的风险因素轨迹。计算了年轻人（18-39 岁）和以后成年人（≥40 岁）期间每个风险因素的时间加权平均暴露量，并将其与随后的冠心病（CHD）、心力衰竭（HF）或中风风险联系起来。
共有 36030 名参与者被纳入。在中位随访 17 年期间，发生了 4570 例 CHD、5119 例 HF 和 2862 例中风事件。当在模型中联合考虑年轻人和以后成年人的危险因素时，与以后成年人的暴露情况无关，年轻人 LDL≥100mg/dl（与<100mg/dl 相比）与 CHD 风险增加 64%相关。同样，年轻人 SBP≥130mmHg（与<120mmHg 相比）与 HF 风险增加 37%相关，年轻人 DBP≥80mmHg（与<80mmHg 相比）与 HF 风险增加 21%相关。
累积的年轻人暴露于升高的收缩压、舒张压和 LDL 与以后生活中 CVD 风险增加相关，与以后成年人的暴露情况无关。
