Menotti A, Jacobs D R, Blackburn H, Kromhout D, Nissinen A, Nedeljkovic S, Buzina R, Mohacek I, Seccareccia F, Giampaoli S, Dontas A, Aravanis C, Toshima H
Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, 55454-1015, USA.
Stroke. 1996 Mar;27(3):381-7. doi: 10.1161/01.str.27.3.381.
This report explores the prediction of long-term stroke mortality in cohorts of the Seven Countries Study.
Sixteen cohorts of men aged 40 to 59 years at entry were examined at years 0, 5, and 10, with mortality follow-up through 25 years.
Stroke death rates in 25 years were high in rural Serbia, Croatia, and Japan; intermediate in Italy, Greece, and urban Serbia; and low in Finland, the Netherlands, and the United States. Age and blood pressure were powerful predictors of 25-year stroke mortality in almost all cohorts and countries. Proportional hazards regression coefficients were .0232 increase in stroke death hazard per millimeter of mercury (t=14.60) for systolic blood pressure and .0409 (t=13.41) for diastolic blood pressure. Moderate blood pressure increases from low usual levels were associated with lower stroke mortality rates in years 10 to 25. Increases of blood pressure starting from high usual levels were associated with increased rates of stroke mortality. Systolic blood pressure was associated with stroke mortality at given levels of diastolic pressure, but diastolic blood pressure was not predictive of stroke mortality at given levels of systolic blood pressure.
Associations of systolic and diastolic blood pressure with stroke mortality were similar in cultures with different stroke mortality rates. Increases in blood pressure were associated with subsequent excess stroke mortality only in those who started from high usual levels; this study finds lower stroke risk in those men whose blood pressure increased moderately from low usual levels. Diastolic blood pressure is not independently associated with stroke risk in these populations.
本报告探讨七国研究队列中脑卒中长期死亡率的预测情况。
对16个初始年龄为40至59岁男性队列在第0年、第5年和第10年进行检查，并对其进行长达25年的死亡率随访。
25年期间，塞尔维亚农村、克罗地亚和日本的脑卒中死亡率较高；意大利、希腊和塞尔维亚城市的死亡率处于中等水平；芬兰、荷兰和美国的死亡率较低。在几乎所有队列和国家中，年龄和血压都是25年脑卒中死亡率的有力预测因素。收缩压每升高1毫米汞柱，脑卒中死亡风险的比例风险回归系数增加0.0232（t = 14.60），舒张压的该系数为0.0409（t = 13.41）。从较低的通常水平适度升高血压与第10至25年较低的脑卒中死亡率相关。从较高的通常水平开始升高血压则与脑卒中死亡率增加相关。在给定舒张压水平下，收缩压与脑卒中死亡率相关，但在给定收缩压水平下，舒张压不能预测脑卒中死亡率。
在脑卒中死亡率不同的文化背景中，收缩压和舒张压与脑卒中死亡率的关联相似。只有那些血压从较高的通常水平开始升高的人群，血压升高才与随后额外的脑卒中死亡率相关；本研究发现，血压从较低的通常水平适度升高的男性脑卒中风险较低。在这些人群中，舒张压与脑卒中风险无独立关联。
