Jousilahti P, Toumilehto J, Vartiainen E, Korhonen H J, Pitkäniemi J, Nissinen A, Puska P
National Public Health Institute, Department of Epidemiology and Health Promotion, Helsinki, Finland.
J Cardiovasc Risk. 1995 Feb;2(1):63-70.
Smoking, a high serum cholesterol level and elevated blood pressure are the most important risk factors for coronary disease. Each of these major risk factors contributes independently to the risk of coronary disease, and clustering of the risk factors may increase the risk more than any of the factors alone.
This study is a 12-year prospective follow-up of 7928 men and 8530 women examined in eastern Finland. Risk factor categories were created by combining smoking status and dichotomized values of serum cholesterol level and blood pressure. Endpoints for the follow-up were either coronary death or a first coronary event (fatal or non-fatal). The effect of risk factor clustering was analyzed by assessing relative risks, mortality and incidence, and population-attributable risks in each of the risk-factor categories.
The relative risks for coronary death and first coronary event in men with all three risk factors (smoking, serum cholesterol > or = 6.5 mmol/l and either systolic blood pressure > or = 160 mmHg or diastolic blood pressure > or = 95 mmHg) were 11.8 and 7.3 respectively, compared with men with none of these factors. The corresponding risk ratios for women were 9.6 and 8.6. The 12-year coronary mortality varied between 10.0 deaths per 10000 person-years in men with none of the risk factors to 98.9 per 10000 person-years in men with all three risk factors. The 12-year incidences in men were 37.4 and 206.3 per 10000 person-years, respectively. The coronary mortality in women varied between 3.4 and 27.9 deaths per 10000 person-years and the incidence between 13.3 and 110.8 per 10000 person-years. Most of the population-attributable risk in men was associated with the combination of smoking with a high serum cholesterol level with elevated blood pressure.
The results illustrate the public-health importance of these major risk of cardiovascular diseases.
吸烟、高血清胆固醇水平和高血压是冠心病最重要的危险因素。这些主要危险因素各自独立地增加冠心病风险，且危险因素的聚集可能比任何单一因素更能增加风险。
本研究对芬兰东部7928名男性和8530名女性进行了为期12年的前瞻性随访。通过结合吸烟状况以及血清胆固醇水平和血压的二分值来划分危险因素类别。随访终点为冠心病死亡或首次冠心病事件（致命或非致命）。通过评估每个危险因素类别中的相对风险、死亡率和发病率以及人群归因风险，分析危险因素聚集的影响。
与无任何这些危险因素的男性相比，具有所有三个危险因素（吸烟、血清胆固醇≥6.5 mmol/l以及收缩压≥160 mmHg或舒张压≥95 mmHg）的男性发生冠心病死亡和首次冠心病事件的相对风险分别为11.8和7.3。女性的相应风险比分别为9.6和8.6。12年冠心病死亡率在无任何危险因素的男性中为每10000人年10.0例死亡，在具有所有三个危险因素的男性中为每10000人年98.9例死亡。男性的12年发病率分别为每10000人年37.4例和206.3例。女性的冠心病死亡率在每10000人年3.4例至27.9例之间，发病率在每10000人年13.3例至110.8例之间。男性中大部分人群归因风险与吸烟、高血清胆固醇水平和高血压的组合相关。
结果表明了这些主要心血管疾病危险因素在公共卫生方面的重要性。
