不同国家冠心病主要危险因素的多变量预测能力比较：七国研究中八个国家25年随访结果

Comparison of multivariate predictive power of major risk factors for coronary heart diseases in different countries: results from eight nations of the Seven Countries Study, 25-year follow-up.

作者信息

Menotti A, Keys A, Blackburn H, Kromhout D, Karvonen M, Nissinen A, Pekkanen J, Punsar S, Fidanza F, Giampaoli S, Seccareccia F, Buzina R, Mohacek I, Nedeljkovic S, Aravanis C, Dontas A, Toshima H, Lanti M

机构信息

Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, USA.

出版信息

J Cardiovasc Risk. 1996 Feb;3(1):69-75.

PMID:8783033

Abstract

BACKGROUND

It was hypothesized that among eight national groups of men aged 40-59 years enrolled in the Seven Countries Study, the multivariate coefficients of major risk factors predicting coronary heart disease mortality over 25 years would be relatively similar.

MATERIALS AND METHODS

Sixteen cohorts were located in eight nations and pooled, comprising one cohort in the USA, two in Finland, one in the Netherlands, three in Italy, two in Croatia (former Yugoslavia), three in Serbia (Yugoslavia), two in Greece and two in Japan, for a total of over 12000 subjects at entry. Coronary heart disease (CHD) mortality was defined as fatal myocardial infarction or sudden coronary death, and proportional hazard models were solved, for each country, with age, serum cholesterol level, systolic blood pressure and cigarette consumption as covariates.

RESULTS

The relationships between risk factors and CHD mortality were statistically significant for all risk factors and for all countries, except for age in Croatia and Japan, cholesterol in Croatia and Japan, systolic blood pressure in Serbia and Greece, and cigarette-smoking in the Netherlands, Croatia, Serbia and Greece. When comparing all pairs of coefficients (28 comparisons for each factor) significant differences were found on four occasions for age, on six occasions for cholesterol, on no occasion for blood pressure and on four occasions for cigarette-smoking. Other tests suggested a substantial homogeneity among multivariate coefficients. Estimates for pooled coefficients were: age, in years, 0.0570 (95% confidence limits 0.0465 and 0.0673); relative risk for 5 years 1.33 (95% confidence limits 1.26 and 1.40); serum cholesterol level in mg/dl, 0.0057 (95% confidence limits 0.0045 and 0.0069); relative risk for 40 mg/dl 1.31 (95% confidence limits 1.20 and 1.31); systolic blood pressure in mmHg, 0.0160, (95% confidence limits 0.0134 and 0.0185), relative risk for 20 mmHg 1.38 (95% confidence limits 1.31 and 1.45); cigarettes per day, 0.0220 (95% confidence limits 0.0170 and 0.0272); relative risk for 10 cigarettes per day 1.25 (95% confidence limits 1.18 and 1.31).

CONCLUSIONS

Great similarities were found in the multivariate coefficients of major coronary risk factors to CHD risk derived from population samples varying in CHD frequency.

摘要

背景

研究假设，在参与七国研究的八个40至59岁男性国家群体中，预测25年冠心病死亡率的主要危险因素的多变量系数会相对相似。

材料与方法

16个队列分布在8个国家并进行合并，包括美国的1个队列、芬兰的2个队列、荷兰的1个队列、意大利的3个队列、克罗地亚（前南斯拉夫）的2个队列、塞尔维亚（南斯拉夫）的3个队列、希腊的2个队列和日本的2个队列，入组时共有超过12000名受试者。冠心病（CHD）死亡率定义为致命性心肌梗死或心源性猝死，并针对每个国家，以年龄、血清胆固醇水平、收缩压和香烟消费量作为协变量，求解比例风险模型。

结果

除克罗地亚和日本的年龄、克罗地亚和日本的胆固醇、塞尔维亚和希腊的收缩压以及荷兰、克罗地亚、塞尔维亚和希腊的吸烟情况外，所有危险因素与冠心病死亡率之间的关系在所有国家均具有统计学意义。在比较所有系数对时（每个因素进行28次比较），年龄有4次、胆固醇有6次、血压无、吸烟有4次发现显著差异。其他检验表明多变量系数之间存在实质性同质性。合并系数的估计值为：年龄（岁），0.0570（95%置信区间0.0465和0.0673）；5年相对风险1.33（95%置信区间1.26和1.40）；血清胆固醇水平（mg/dl），0.0057（95%置信区间0.0045和0.0069）；40mg/dl相对风险1.31（95%置信区间1.20和1.43）；收缩压（mmHg），0.0160（95%置信区间0.0134和0.0185），20mmHg相对风险1.38（95%置信区间1.31和1.45）；每日吸烟量，0.0220（95%置信区间0.0170和0.0272）；每日10支烟相对风险1.25（95%置信区间1.18和1.31）。