Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University.
Department of Hygiene and Public Health, Teikyo University School of Medicine.
J Atheroscler Thromb. 2021 Jan 1;28(1):6-24. doi: 10.5551/jat.52613. Epub 2020 Apr 8.
Lifetime risk (LTR) indicates the absolute risk of disease during the remainder of an individual's lifetime. We aimed to assess the LTRs for coronary heart disease (CHD) mortality associated with blood pressure (BP) and total cholesterol levels in an Asian population using a meta-analysis of individual participant data because no previous studies have assessed this risk.
We analyzed data from 105,432 Japanese participants in 13 cohorts. Apart from grade 1 and 2-3 hypertension groups, we defined "normal BP" as systolic/diastolic BP ＜130/＜80 mmHg and "high BP" as 130-139/80-89 mmHg. The sex-specific LTR was estimated while considering the competing risk of death.
During the mean follow-up period of 15 years (1,553,735 person-years), 889 CHD deaths were recorded. The 10-year risk of CHD mortality at index age 35 years was ≤ 0.11%, but the corresponding LTR was ≥ 1.84%. The LTR of CHD at index age 35 years steeply increased with an increase in BP of participants with high total cholesterol levels [≥ 5.7 mmol/L (220 mg/dL)]. This risk was 7.73%/5.77% (95% confidence interval: 3.53%-10.28%/3.83%-7.25%) in men/women with grade 2-3 hypertension and high total cholesterol levels. In normal and high BP groups, the absolute differences in LTRs between the low and high total cholesterol groups were ≤ 0.25% in men and ≤ 0.40% in women.
High total cholesterol levels contributed to an elevated LTR of CHD mortality in hypertensive individuals. These findings could help guide high-risk young individuals toward initiating lifestyle changes or treatments.
终生风险（LTR）表示个体在剩余生命期间患疾病的绝对风险。我们旨在使用个体参与者数据的荟萃分析来评估与血压（BP）和总胆固醇水平相关的冠心病（CHD）死亡率的 LTR，因为以前没有研究评估过这种风险。
我们分析了来自 13 个队列的 105432 名日本参与者的数据。除了 1 级和 2-3 级高血压组外，我们将“正常 BP”定义为收缩压/舒张压＜130/＜80mmHg，“高 BP”定义为 130-139/80-89mmHg。在考虑死亡的竞争风险的同时，估计了特定性别 LTR。
在平均 15 年（1553735 人年）的随访期间，记录了 889 例 CHD 死亡。在指数年龄 35 岁时，CHD 死亡的 10 年风险≤0.11%，但相应的 LTR≥1.84%。在指数年龄 35 岁时，高总胆固醇水平的参与者的 BP 升高与 CHD 的 LTR 急剧增加相关[≥5.7mmol/L（220mg/dL）]。在 2-3 级高血压和高总胆固醇水平的男性/女性中，该风险分别为 7.73%/5.77%（95%置信区间：3.53%-10.28%/3.83%-7.25%）。在正常和高 BP 组中，低和高总胆固醇组之间 LTR 的绝对差异在男性中≤0.25%，在女性中≤0.40%。
高总胆固醇水平导致高血压个体的 CHD 死亡率升高的 LTR 升高。这些发现可以帮助指导高危年轻个体开始生活方式改变或治疗。
