Karadimas Thomas, Meier Helen C S
Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI.
Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor.
BMJ Public Health. 2024 Jul;2(2). doi: 10.1136/bmjph-2023-000455. Epub 2024 Oct 22.
Hypertension and dyslipidemia are established risk factors for cardiovascular disease (CVD), but are often insufficient alone in predicting CVD. Inflammation also contributes to CVD, but research on the co-occurrence of inflammation, hypertension, and dyslipidemia and CVD risk is limited. Knowledge of inflammatory status in addition to other risk factors is vital for clinicians to correctly evaluate patients for CVD risk.
Prospective data from the Health and Retirement Study, a representative cohort of US adults over 50 years of age (n = 7895) were used. The average participant age was 68.8 years, and 54.9% were female. 80.7% were Non-Hispanic White, 10.1% were Non-Hispanic Black, and 9.2% were Hispanic. Hypertension, dyslipidemia, and elevated C-reactive protein (CRP) were used to create a CVD risk score: low (0-1 factors), medium (2 factors), or high (all 3 factors). Measurement and definition guidelines for these variables are thoroughly explained in the methods section. Weighted logistic regression models estimated the odds ratio (OR) of 1) prevalent and incident CVD for medium and high-risk groups versus the low-risk group and 2) 4-year mortality adjusting for covariates.
Cross-sectionally, high-risk participants (n=1706) had significantly higher odds of CVD prevalence compared to participants with low-risk (n=3107) (adjusted OR = 1.54, 95% CI: [1.29 - 1.84]). Medium-risk (n=3082) participants had higher odds of CVD prevalence, though this did not reach significance. Prospectively, medium and high-risk participants had significantly higher odds of 4-year CVD incidence (medium-risk adjusted OR = 1.57, 95% CI: [1.18 - 2.09]; high-risk adjusted OR = 1.67, 95% CI: [1.19 - 2.36]) compared to those with low-risk. Risk of 4-year mortality was higher in high-risk (OR = 2.12, 95% CI: [1.60 - 2.8]) participants vs. low-risk, and non-significantly elevated in medium-risk participants.
Co-occurrence of hypertension, dyslipidemia, and elevated CRP was strongly associated with increased CVD prevalence, higher incident CVD, and elevated 4-year mortality in older US adults, emphasizing the importance of multifactor screening for CVD risk.
高血压和血脂异常是公认的心血管疾病（CVD）危险因素，但单独往往不足以预测CVD。炎症也与CVD有关，但关于炎症、高血压、血脂异常同时出现与CVD风险的研究有限。了解除其他危险因素外的炎症状态对于临床医生正确评估患者的CVD风险至关重要。
使用来自健康与退休研究的前瞻性数据，该研究是美国50岁以上成年人的代表性队列（n = 7895）。参与者的平均年龄为68.8岁，54.9%为女性。80.7%为非西班牙裔白人，10.1%为非西班牙裔黑人，9.2%为西班牙裔。使用高血压、血脂异常和高敏C反应蛋白（CRP）升高来创建CVD风险评分：低（0 - 1个因素）、中（2个因素）或高（所有3个因素）。这些变量的测量和定义指南在方法部分有详细解释。加权逻辑回归模型估计了1）中、高风险组与低风险组相比CVD患病率和发病率的比值比（OR），以及2）调整协变量后的4年死亡率的OR。
横断面研究中，高风险参与者（n = 1706）的CVD患病率显著高于低风险参与者（n = 3107）（调整后的OR = 1.54，95% CI：[1.29 - 1.84]）。中风险（n = 3082）参与者的CVD患病率较高，尽管未达到显著水平。前瞻性研究中，中、高风险参与者的4年CVD发病率显著高于低风险参与者（中风险调整后的OR = 1.57，95% CI：[1.18 - 2.09]；高风险调整后的OR = 1.67，95% CI：[1.19 - 2.36]）。高风险参与者的4年死亡率风险高于低风险参与者（OR = 2.12，95% CI：[1.60 - 2.8]），中风险参与者的死亡率略有升高但不显著。
高血压、血脂异常和CRP升高同时出现与美国老年成年人CVD患病率增加、CVD发病率升高和4年死亡率升高密切相关，强调了对CVD风险进行多因素筛查的重要性。
