Corti M C, Salive M E, Guralnik J M
Epidemiology, Demography, and Biometry Program, National Institute on Aging, National Institutes of Health, Bethesda, Maryland 20892-9205, USA.
J Clin Epidemiol. 1996 May;49(5):519-26. doi: 10.1016/0895-4356(95)00562-5.
The role of traditional risk factors in predicting coronary heart disease (CHD) among men and women aged 65 years and over has been extensively debated, but the search for risk factors that are distinctive in the elderly is still ongoing. The relation of serum albumin levels and physical disability to risk of CHD morality and incidence was prospectively assessed in a cohort of 4116 men and women, aged 71 years and over, who were evaluated in 1987-1989 and followed for a mean of 4.0 years. Outcome events were based on death certificates and Medicare hospitalization records. Analyses were adjusted for major CHD risk factors. There were 275 CHD deaths (16.8/1000 person-years) among all participants and 503 incident (fatal and nonfatal) CHD events (39.4 per 1000 person-years) among participants free of prevalent CHD during the observation period. The relative risk (RR) of CHD morality for women with an albumin concentration < 38 g/liter was 2.5 times higher than for women with albumin > 43 g/liter (RR 2.5; 95% confidence interval [CI], 1.4-4.6). There was a significant and graded increase in CHD incidence with decreasing albumin concentration in women but not in men. The presence of physical disability doubled the risk of CHD mortality among both men and women, an increase in risk that was comparable to that imposed by a previous myocardial infarction and was independent of other coronary risk factors. Disability had a lesser impact on CHD incidence, which was significant only in women. Low albumin concentration (< 38 g/liter) identifies a group of women at higher risk of CHD mortality and incidence. Physical disability is an independent predictor of CHD mortality in both men and women and for CHD incidence only in women.
传统风险因素在预测65岁及以上男性和女性冠心病（CHD）方面的作用一直存在广泛争议，但寻找老年人特有的风险因素仍在进行中。在一个由4116名71岁及以上男性和女性组成的队列中，前瞻性评估了血清白蛋白水平和身体残疾与冠心病死亡率和发病率风险之间的关系。这些人在1987 - 1989年接受评估，并平均随访4.0年。结局事件基于死亡证明和医疗保险住院记录。分析对主要的冠心病风险因素进行了调整。在所有参与者中，有275例冠心病死亡（16.8/1000人年），在观察期内无冠心病病史的参与者中有503例（致命和非致命）冠心病事件（39.4/1000人年）。白蛋白浓度<38 g/升的女性冠心病死亡率的相对风险（RR）比白蛋白>43 g/升的女性高2.5倍（RR 2.5；95%置信区间[CI]，1.4 - 4.6）。女性中，随着白蛋白浓度降低，冠心病发病率有显著的分级增加，而男性则没有。身体残疾使男性和女性的冠心病死亡率风险增加一倍，这种风险增加与既往心肌梗死造成的风险相当，且独立于其他冠状动脉风险因素。残疾对冠心病发病率的影响较小，仅在女性中显著。低白蛋白浓度（<38 g/升）确定了一组冠心病死亡率和发病率风险较高的女性。身体残疾是男性和女性冠心病死亡率的独立预测因素，且仅在女性中是冠心病发病率的独立预测因素。
