慢性呼吸系统症状与心血管疾病事件和全因死亡率的关系：来自年轻人冠状动脉风险发展研究的结果。
Association of Chronic Respiratory Symptoms With Incident Cardiovascular Disease and All-Cause Mortality: Findings From the Coronary Artery Risk Development in Young Adults Study.
机构信息
Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Lab of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China; Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
Department of Ultrasound Medicine, Laboratory of Ultrasound Molecular Imaging, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
出版信息
Chest. 2022 Apr;161(4):1036-1045. doi: 10.1016/j.chest.2021.10.029. Epub 2021 Nov 2.
BACKGROUND
Respiratory and cardiovascular diseases (CVDs) frequently coexist; however, there is limited evidence on the relationship between chronic respiratory symptoms in young adulthood and late-onset CVD.
RESEARCH QUESTION
Are chronic respiratory symptoms in young adulthood associated with CVD and all-cause mortality in later life?
STUDY DESIGN AND METHODS
A total of 4,621 participants from the Coronary Artery Risk Development in Young Adults Study (CARDIA) cohort study aged 18 to 30 years were included. Chronic respiratory symptoms were identified through respiratory symptom questionnaires in two consecutive examinations. Incident CVD and all-cause mortality were adjudicated over 30-year follow-up. Multivariable Cox proportional hazards models were used to explore the association of chronic respiratory symptoms with incident CVD and all-cause mortality.
RESULTS
During a median follow-up of 30.9 years, 284 CVD events (6.15%) and 378 deaths (8.18%) occurred. Following multivariable adjustment for demographic characteristics, cardiovascular risk factors, smoking, and lung function, the hazard ratios (95% CIs) for CVD events were 1.51 (1.18-1.93) for any respiratory symptom, 1.57 (1.18-2.09) for cough or phlegm, 1.31 (1.01-1.68) for wheeze, 1.73 (1.25-2.41) for shortness of breath, and 1.32 (1.01-1.71) for chest illnesses. Similar findings were also observed in all-cause mortality. Comparing zero vs three to four respiratory symptoms, the hazard ratios (95% CIs) were 1.97 (1.34-2.91) for CVD and 1.75 (1.23-2.47) for all-cause mortality. Similar results were observed in various sensitivity analyses.
INTERPRETATION
Chronic respiratory symptoms in young adulthood are associated with an increased risk of CVD and all-cause mortality in midlife independent of established cardiovascular risk factors, smoking, and lung function. Identifying chronic respiratory symptoms in young adulthood may help provide prognostic information regarding future cardiovascular health.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov; No.: NCT00005130; URL: https://www.
CLINICALTRIALS
gov.
背景
呼吸系统疾病和心血管疾病（CVDs）经常同时存在；然而，关于年轻人慢性呼吸系统症状与迟发性 CVD 的关系，目前证据有限。
研究问题
年轻人的慢性呼吸系统症状是否与晚年 CVD 和全因死亡率有关？
研究设计和方法
本研究共纳入来自冠状动脉风险发展（CARDIA）队列研究的 4621 名年龄在 18 至 30 岁的参与者。通过两次连续检查中的呼吸系统症状问卷确定慢性呼吸系统症状。在 30 年的随访期间，确定了 CVD 事件和全因死亡率。使用多变量 Cox 比例风险模型探讨慢性呼吸系统症状与 CVD 事件和全因死亡率的关系。
结果
在中位随访 30.9 年期间，发生了 284 例 CVD 事件（6.15%）和 378 例死亡（8.18%）。在调整人口统计学特征、心血管危险因素、吸烟和肺功能后，任何呼吸系统症状的 CVD 事件风险比（95%CI）为 1.51（1.18-1.93），咳嗽或咳痰为 1.57（1.18-2.09），喘息为 1.31（1.01-1.68），呼吸急促为 1.73（1.25-2.41），胸部疾病为 1.32（1.01-1.71）。全因死亡率也观察到类似的发现。比较零 vs 三到四个呼吸系统症状，CVD 的风险比（95%CI）为 1.97（1.34-2.91），全因死亡率为 1.75（1.23-2.47）。在各种敏感性分析中也观察到类似的结果。
解释
年轻人的慢性呼吸系统症状与中年 CVD 和全因死亡率的风险增加独立于已确立的心血管危险因素、吸烟和肺功能有关。在年轻人中识别慢性呼吸系统症状可能有助于提供关于未来心血管健康的预后信息。
临床试验注册
ClinicalTrials.gov；编号：NCT00005130；网址：https://www.clinicaltrials.gov.
临床试验
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