心血管疾病与其经典危险因素之间关联的区域和时间差异：对来自11个欧洲国家的49个队列的分析

Regional and temporal differences in the associations between cardiovascular disease and its classic risk factors: an analysis of 49 cohorts from 11 European countries.

作者信息

Reinikainen Jaakko, Kuulasmaa Kari, Oskarsson Viktor, Amouyel Philippe, Biasch Katia, Brenner Hermann, De Ponti Roberto, Donfrancesco Chiara, Drygas Wojciech, Ferrieres Jean, Grassi Guido, Grimsgaard Sameline, Iacoviello Licia, Jousilahti Pekka, Kårhus Line L, Kee Frank, Linneberg Allan, Luksiene Dalia, Mariño Joany, Moitry Marie, Palmieri Luigi, Peters Annette, Piwonska Aleksandra, Quarti-Trevano Fosca, Salomaa Veikko, Sans Susana, Schmidt Carsten Oliver, Schöttker Ben, Söderberg Stefan, Tamosiunas Abdonas, Thorand Barbara, Tunstall-Pedoe Hugh, Vanuzzo Diego, Veronesi Giovanni, Woodward Mark, Lekadir Karim, Niiranen Teemu

机构信息

Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), P.O. Box 30, FI-00271 Helsinki, Finland.

Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.

出版信息

Eur J Prev Cardiol. 2024 Mar 27;31(5):569-577. doi: 10.1093/eurjpc/zwad359.

DOI:10.1093/eurjpc/zwad359

PMID:37976098

Abstract

AIMS

The regional and temporal differences in the associations between cardiovascular disease (CVD) and its classic risk factors are unknown. The current study examined these associations in different European regions over a 30-year period.

METHODS AND RESULTS

The study sample comprised 553 818 individuals from 49 cohorts in 11 European countries (baseline: 1982-2012) who were followed up for a maximum of 10 years. Risk factors [sex, smoking, diabetes, non-HDL cholesterol, systolic blood pressure (BP), and body mass index (BMI)] and CVD events (coronary heart disease or stroke) were harmonized across cohorts. Risk factor-outcome associations were analysed using multivariable-adjusted Cox regression models, and differences in associations were assessed using meta-regression. The differences in the risk factor-CVD associations between central Europe, northern Europe, southern Europe, and the UK were generally small. Men had a slightly higher hazard ratio (HR) in southern Europe (P = 0.043 for overall difference), and those with diabetes had a slightly lower HR in central Europe (P = 0.022 for overall difference) compared with the other regions. Of the six CVD risk factors, minor HR decreases per decade were observed for non-HDL cholesterol [7% per mmol/L; 95% confidence interval (CI), 3-10%] and systolic BP (4% per 20 mmHg; 95% CI, 1-8%), while a minor HR increase per decade was observed for BMI (7% per 10 kg/m2; 95% CI, 1-13%).

CONCLUSION

The results demonstrate that all classic CVD risk factors are still relevant in Europe, irrespective of regional area. Preventive strategies should focus on risk factors with the greatest population attributable risk.

摘要

目的

心血管疾病（CVD）与其经典危险因素之间关联的区域和时间差异尚不清楚。本研究在30年期间对不同欧洲区域的这些关联进行了调查。

方法与结果

研究样本包括来自11个欧洲国家49个队列的553818名个体（基线：1982 - 2012年），随访时间最长为10年。对各队列中的危险因素[性别、吸烟、糖尿病、非高密度脂蛋白胆固醇、收缩压（BP）和体重指数（BMI）]以及CVD事件（冠心病或中风）进行了统一。使用多变量调整的Cox回归模型分析危险因素与结局的关联，并使用meta回归评估关联差异。中欧、北欧、南欧和英国之间危险因素与CVD关联的差异通常较小。与其他地区相比，男性在南欧的风险比（HR）略高（总体差异P = 0.043），而糖尿病患者在中欧的HR略低（总体差异P = 0.022）。在六个CVD危险因素中，非高密度脂蛋白胆固醇[每毫摩尔/升降低7%；95%置信区间（CI），3 - 10%]和收缩压（每20 mmHg降低4%；95% CI，1 - 8%）每十年的HR略有下降，而BMI每十年的HR略有上升（每10 kg/m²增加7%；95% CI，1 - 13%）。