量化心血管危险因素对21世纪日本心血管疾病趋势的影响：一项微观模拟研究。
Quantifying the contributions of cardiovascular risk factors to cardiovascular disease trends in 21st century Japan: a microsimulation study.
作者信息
Ogata Soshiro, Kiyoshige Eri, Yoshikawa Yusuke, Iihara Koji, Fukuda Hitoshi, Ishii Masanobu, Tsujita Kenichi, Head Anna, Collins Brendan, O'Flaherty Martin, Nishimura Kunihiro, Kypridemos Chris
机构信息
Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, 564-8565, Japan.
Department of Biostatistics, National Cerebral and Cardiovascular Center, Suita, Osaka, 564-8565, Japan.
出版信息
Lancet Reg Health West Pac. 2025 Jul 8;60:101623. doi: 10.1016/j.lanwpc.2025.101623. eCollection 2025 Jul.
BACKGROUND
Recent stagnation or worsening trends in cardiovascular disease (CVD) risk factors, including low-density lipoprotein cholesterol (LDL-c) and obesity, might slow the decline in Japan's CVD burden. We aimed to quantify the impact of national changes in CVD risk factor distributions on Japan's CVD burden from 2001 to 2019.
METHODS
We conducted a microsimulation study with counterfactual analysis using IMPACT, a validated model based on real-world data. It simulated a synthetic Japanese population (ages 30-99) from 2001 to 2019 using life-course data on seven CVD risk factors, estimating CVD incidence, mortality, and healthcare economics for synthetic individuals. The base-case reflected observed trends; counterfactual scenarios assumed 2001 levels persisted. Primary outcome was national CVD incidence (stroke and coronary heart disease).
FINDINGS
From 2001 to 2019, systolic blood pressure (SBP) and smoking declined markedly (men/women) by 6·8/7·2 mmHg and 18·4/6·8%, respectively, while LDL-c, HbA1c, body mass index (BMI), physical activity (PA), and fruit/vegetable (FV) consumption showed smaller or adverse trends. Under the base-case and counterfactual scenarios, IMPACT estimated CVD incidence and quantified the differences between the scenarios. The changes in the CVD risk factors prevented or postponed 840,000 (95% uncertainty interval: 540,000-1,300,000) national CVD cases, cumulative from 2001 to 2019. Individual contributions were: SBP 540,000; smoking 280,000; LDL-c 27,000; HbA1c 7900; BMI -15,000; PA -16,000; and FV consumption -11,000.
INTERPRETATION
SBP and smoking reductions drove most CVD burden declines in Japan (2001-2019). Modest benefits came from LDL-c and HbA1c, while rising BMI, and low PA and FV intake partly offset these benefits.
FUNDING
JSPS KAKENHIJP22K17821, JP25K02863; the Ministry of Health, Labour and Welfare Comprehensive Research on Life-Style Related 22FA1015, 24FA1015.
背景
包括低密度脂蛋白胆固醇（LDL-c）和肥胖在内的心血管疾病（CVD）危险因素近期出现停滞或恶化趋势，这可能会减缓日本心血管疾病负担的下降速度。我们旨在量化2001年至2019年日本心血管疾病危险因素分布的全国性变化对其心血管疾病负担的影响。
方法
我们使用IMPACT进行了一项带有反事实分析的微观模拟研究，IMPACT是一个基于真实世界数据的经过验证的模型。它利用七种心血管疾病危险因素的生命历程数据模拟了2001年至2019年的合成日本人口（年龄30 - 99岁），估计合成个体的心血管疾病发病率、死亡率和医疗经济学情况。基础病例反映了观察到的趋势；反事实情景假设2001年的水平持续存在。主要结局是全国心血管疾病发病率（中风和冠心病）。
结果
从2001年到2019年，收缩压（SBP）和吸烟率（男性/女性）显著下降，分别下降了6.8/7.2 mmHg和18.4/6.8%，而LDL-c、糖化血红蛋白（HbA1c）、体重指数（BMI）、身体活动（PA）以及水果/蔬菜（FV）摄入量呈现出较小的或不利的趋势。在基础病例和反事实情景下，IMPACT估计了心血管疾病发病率并量化了两种情景之间的差异。心血管疾病危险因素的变化在2001年至2019年期间累计预防或推迟了840,000例（95%不确定区间：540,000 - 1,300,000）全国性心血管疾病病例。个体贡献分别为：SBP 540,000例；吸烟280,000例；LDL-c 27,000例；HbA1c 7900例；BMI -15,000例；PA -16,000例；FV摄入量 -11,000例。
解读
收缩压降低和吸烟率下降推动了日本（2001 - 2019年）大部分心血管疾病负担的下降。LDL-c和HbA1c带来了一定益处，而BMI上升、身体活动水平低以及水果/蔬菜摄入量低部分抵消了这些益处。
资金来源
日本学术振兴会科研资助项目JP22K17821、JP25K02863；厚生劳动省生活方式相关综合研究22FA1015、24FA1015。
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