Kuller L H, Shemanski L, Psaty B M, Borhani N O, Gardin J, Haan M N, O'Leary D H, Savage P J, Tell G S, Tracy R
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA 15261, USA.
Circulation. 1995 Aug 15;92(4):720-6. doi: 10.1161/01.cir.92.4.720.
The primary aim of the present study was to determine the relation between measures of subclinical cardiovascular disease and the incidence of clinical cardiovascular disease among 5201 adults 65 years of age or older who were participating in the Cardiovascular Health Study.
A new method of classifying subclinical disease at baseline examination in the Cardiovascular Health Study included measures of ankle-brachial blood pressure, carotid artery stenosis and wall thickness, ECG and echocardiographic abnormalities, and positive response to the Rose Angina and Claudication Questionnaire. Participants were followed for an average of 2.39 years (maximum, 3 years). For participants without evidence of clinical cardiovascular disease at baseline, the presence of subclinical disease compared with no subclinical disease was associated with a significant increased risk of incident total coronary heart disease including CHD deaths and nonfatal MI and angina pectoris for both men and women. For individuals with subclinical disease, the increased risk of total coronary heart disease was 2.0 for men and 2.5 for women, and the increased risk of total mortality was 2.9 for men and 1.7 for women. The increased risk changed little after adjustment for other risk factors, including lipoprotein levels, blood pressure, smoking, and diabetes.
The measurement of subclinical disease provides an approach for identifying high-risk older individuals who may be candidates for more active intervention to prevent clinical disease.
本研究的主要目的是确定5201名65岁及以上参与心血管健康研究的成年人中亚临床心血管疾病指标与临床心血管疾病发病率之间的关系。
心血管健康研究中一种在基线检查时对亚临床疾病进行分类的新方法，包括测量踝臂血压、颈动脉狭窄和管壁厚度、心电图和超声心动图异常，以及对罗斯心绞痛和间歇性跛行问卷的阳性反应。参与者平均随访2.39年（最长3年）。对于基线时无临床心血管疾病证据的参与者，与无亚临床疾病相比，亚临床疾病的存在与男性和女性发生包括冠心病死亡、非致命性心肌梗死和心绞痛在内的总冠心病事件的风险显著增加相关。对于患有亚临床疾病的个体，男性总冠心病风险增加2.0倍，女性增加2.5倍；男性总死亡率增加2.9倍，女性增加1.7倍。在调整包括脂蛋白水平、血压、吸烟和糖尿病等其他危险因素后，增加的风险变化不大。
亚临床疾病的测量为识别可能是更积极干预以预防临床疾病的高危老年个体提供了一种方法。
