Sigurdsson E, Sigfusson N, Agnarsson U, Sigvaldason H, Thorgeirsson G
Heart Preventive Clinic, Reykjavik, Iceland.
Int J Epidemiol. 1995 Feb;24(1):58-68. doi: 10.1093/ije/24.1.58.
While coronary heart disease (CHD) is a serious and often fatal disease the prognosis is variable and major effort has been invested in risk stratification. The purpose of this study was to examine the relation between long-term prognosis and risk factors in different clinical categories of CHD.
A general population sample of 9141 men, aged 34-79 at entry into the study was divided into six groups with respect to manifestations of CHD at entry: I. Symptomatic infarction. II. Silent or unrecognized infarction. III. Angina pectoris with ischaemic changes on ECG. IV. Angina without ischaemic changes. V. Angina by Rose questionnaire but not confirmed by a physician. VI. No manifestations of CHD.
The risk factor profile varied considerably between the different categories and by life-table analysis marked differences in survival were demonstrated between the groups. The risk factors maintained their detrimental effects on prognosis in the presence of CHD. Thus, age, serum total cholesterol, impaired glucose tolerance and smoking were found by Cox's regression to be statistically significant independent risk factors of CHD mortality among men having manifestations of CHD (groups I-V). Furthermore, the composite risk score, a measure of the overall risk factor exposures had marked effect on the prognosis of the various CHD groups. When the comprehensive risk factor score for both CHD mortality and all-cause mortality was accounted for marked differences persisted in the long-term prognosis. Compared to those without CHD the infarct groups had about a 7.6- and 3.7-fold risk of dying from CHD and all causes respectively. Those with angina had from 2.5- to 3.2-fold risk of CHD mortality and 1.7- to 2.2-fold risk of all-cause mortality depending on the subgroup of angina, again compared to those without manifestations of CHD.
Different categories of CHD had different risk factor profiles and the long-term prognosis resulted from a complex interplay between those factors and the diagnostic category of CHD. The risk factors maintained their detrimental effects on prognosis in the presence of CHD and after accounting for the comprehensive risk factor score marked differences persisted in the long-term prognosis, being worst for those having suffered a myocardial infarction, either symptomatic or silent.
虽然冠心病（CHD）是一种严重且往往致命的疾病，但其预后存在差异，人们已在风险分层方面投入了大量精力。本研究的目的是探讨不同临床类型冠心病的长期预后与危险因素之间的关系。
一项针对9141名男性的一般人群样本研究，研究开始时年龄在34 - 79岁，根据研究开始时冠心病的表现分为六组：I. 有症状的心肌梗死。II. 无症状或未被识别的心肌梗死。III. 心电图有缺血改变的心绞痛。IV. 无缺血改变的心绞痛。V. 根据罗斯问卷诊断为心绞痛但未得到医生证实。VI. 无冠心病表现。
不同类别之间的危险因素特征差异很大，通过寿命表分析显示各组之间的生存存在显著差异。在患有冠心病的情况下，这些危险因素对预后仍有不利影响。因此，通过Cox回归发现，年龄、血清总胆固醇、糖耐量受损和吸烟是有冠心病表现的男性（I - V组）中冠心病死亡的统计学显著独立危险因素。此外，综合风险评分，一种衡量总体危险因素暴露情况的指标，对各种冠心病组的预后有显著影响。当考虑冠心病死亡率和全因死亡率的综合危险因素评分时，长期预后仍存在显著差异。与无冠心病者相比，梗死组死于冠心病和所有原因的风险分别约为7.6倍和3.7倍。根据心绞痛的亚组情况，心绞痛患者的冠心病死亡风险为2.5至3.2倍，全因死亡风险为1.7至2.2倍，同样与无冠心病表现者相比。
不同类型的冠心病有不同的危险因素特征，长期预后是这些因素与冠心病诊断类型之间复杂相互作用的结果。在患有冠心病的情况下，这些危险因素对预后仍有不利影响，在考虑综合危险因素评分后，长期预后仍存在显著差异，对有症状或无症状心肌梗死患者最为不利。
