Global Health Research Center, Duke Kunshan University, Kunshan, 215316, Jiangsu, China.
Duke Global Health Institute, Duke University, Durham, NC, USA.
J Gen Intern Med. 2021 Jul;36(7):2048-2054. doi: 10.1007/s11606-020-06398-6. Epub 2021 Jan 19.
Whether high burden of subclinical vascular disease (SVD) is associated with increased premature mortality among middle-aged adults is not adequately understood. The association of midlife SVD burden with premature mortality among middle-aged adults free of clinical cardiovascular disease (CVD) could provide further insights into stratifying premature death beyond clinical CVD.
To determine whether high burden of subclinical vascular disease is associated with increased premature mortality among middle-aged adults.
We leveraged data from the Atherosclerosis Risk in Communities Study.
Thirteen thousand eight hundred seventy-six community-dwelling blacks and whites aged 45-64 years from the Atherosclerosis Risk in Communities Study.
Each SVD measure-ankle-brachial index, carotid intima-media thickness, and electrocardiogram-was scored 0 (no abnormalities), 1 (minor abnormalities), or 2 (major abnormalities). An index was constructed as the sum of three measures, ranging from 0 (lowest burden) to 6 (highest burden). We used the Cox proportional-hazards model to determine the association of SVD burden with premature mortality (death before age 70) among persons free of clinical CVD. We then tested the difference in point estimates between SVD and clinical CVD.
Among persons without CVD, the premature death was 1.7, 2.1, 2.5, and 3.8 per 1000 person-years among those with an SVD score of 0 (lowest burden), 1, 2, and 3-6 (highest burden), respectively. After multivariable-adjustment, highest SVD burden (score = 3-6; HR = 1.47) was significantly associated with premature death among persons initially without CVD. In the model where persons with and without CVD were included, high SVD burden (score: 3-6 vs. 0) and CVD did not have hugely different association with premature death (HR = 1.49 vs. 1.68; P = 0.32 for comparison).
Midlife SVD burden was associated with premature mortality and it could stratify premature death beyond clinical CVD. It is important to take SVD into account when designing interventions for reducing premature mortality.
亚临床血管疾病（SVD）负担较高是否与中年人群的过早死亡相关，目前尚不清楚。了解中年人群亚临床血管疾病负担与无临床心血管疾病（CVD）中年人群的过早死亡之间的关系，可以进一步深入了解除临床 CVD 以外的过早死亡分层。
确定亚临床血管疾病负担较高是否与中年人群的过早死亡相关。
我们利用了来自社区动脉粥样硬化风险研究的数据。
来自社区动脉粥样硬化风险研究的 13876 名年龄在 45-64 岁之间的社区居住的黑人和白人。
每项 SVD 测量指标 - 踝臂指数、颈动脉内膜中层厚度和心电图 - 评分 0（无异常）、1（轻度异常）或 2（重度异常）。指数构建为三个测量指标的总和，范围为 0（最低负担）至 6（最高负担）。我们使用 Cox 比例风险模型来确定 SVD 负担与无临床 CVD 人群的过早死亡（70 岁前死亡）之间的关联。然后，我们测试了 SVD 和临床 CVD 之间的点估计值差异。
在没有 CVD 的人群中，SVD 评分分别为 0（最低负担）、1、2 和 3-6（最高负担）的人群中，过早死亡分别为每 1000 人年 1.7、2.1、2.5 和 3.8 例。经过多变量调整后，SVD 负担最高（评分=3-6；HR=1.47）与最初无 CVD 的人群的过早死亡显著相关。在包括有和没有 CVD 的人群的模型中，高 SVD 负担（评分：3-6 与 0）和 CVD 与过早死亡的关联并没有太大差异（HR=1.49 与 1.68；P=0.32 用于比较）。
中年 SVD 负担与过早死亡相关，它可以对临床 CVD 以外的过早死亡进行分层。在设计降低过早死亡的干预措施时，考虑 SVD 非常重要。
