LaMorte W W, Scott T E, Menzoian J O
Surgical Research Section, Boston University School of Medicine, Massachusetts 02118-2394, USA.
Ann N Y Acad Sci. 1996 Nov 18;800:25-35. doi: 10.1111/j.1749-6632.1996.tb33295.x.
Atherosclerosis is more severe in blacks than in whites, but abdominal aortic aneurysms, which have traditionally been thought to have an atherosclerotic etiology, appear to be less common in blacks. Because of this incongruity, we compared risk factor profiles in patients undergoing abdominal aortic aneurysm repair and patients undergoing femoral bypass for atherosclerotic occlusive disease. A dual case-control study was conducted, first, comparing patients who had undergone aneurysmectomy to a control group of patients who had undergone appendectomy; and then comparing patients who had undergone femoral bypass surgery to the same appendectomy controls. We initially used hospital discharge data for the entire state of Massachusetts and, in a second phase, data obtained from a review of medical records from Boston University Medical Center Hospital and Boston City Hospital. The statewide database indicated that rates of femoral bypass surgery were higher in blacks than in whites, but after adjusting for differences in hypertension, diabetes, and low socioeconomic status, the black/white odds ratio for femoral bypass fell to 1.44 (95% confidence interval: 1.08, 1.92). A similar analysis based on the hospital chart review, provided better control of confounding and indicated that there was no racial difference in rates of femoral bypass after correcting for other risk factors (odds ratio = 0.94; 95% confidence interval: 0.40, 2.22; p = 0.90). In contrast, the statewide database found higher rates of abdominal aortic aneurysm surgery in whites, and particularly in white males. Smoking and hypertension were strong risk factors for aneurysmectomy, but diabetes mellitus and socioeconomic status were not. After adjusting for other variables, the black/white odds ratio for aneurysmectomy was 0.29 (95% confidence interval: 0.07, 1.23; p = 0.09).
Substantial differences are found in the risk factor profiles for aneurysmal disease and femoral atherosclerotic occlusive disease. Diabetes is a particularly strong risk factor for femoral disease, but not for aneurysmal disease. In addition, blacks had higher rates of femoral bypass surgery in Massachusetts, but the apparent racial difference appeared to be due to a greater prevalence of hypertension, smoking, and diabetes in blacks. In contrast, abdominal aortic aneurysms occurred predominantly in white males, and adjustment for other risk factors further accentuated the greater risk in whites.
动脉粥样硬化在黑人中比在白人中更严重，但腹主动脉瘤传统上被认为具有动脉粥样硬化病因，在黑人中似乎不太常见。由于这种不一致性，我们比较了接受腹主动脉瘤修复的患者和因动脉粥样硬化闭塞性疾病接受股动脉搭桥手术的患者的危险因素概况。进行了一项双重病例对照研究，首先，将接受动脉瘤切除术的患者与接受阑尾切除术的对照组患者进行比较；然后将接受股动脉搭桥手术的患者与相同的阑尾切除术对照组进行比较。我们最初使用了马萨诸塞州全州的医院出院数据，在第二阶段，使用了从波士顿大学医学中心医院和波士顿市医院的病历审查中获得的数据。全州数据库表明，黑人的股动脉搭桥手术率高于白人，但在调整了高血压、糖尿病和低社会经济地位的差异后，股动脉搭桥手术的黑人/白人比值比降至1.44（95%置信区间：1.08，1.92）。基于医院病历审查的类似分析更好地控制了混杂因素，并表明在纠正其他危险因素后，股动脉搭桥手术率没有种族差异（比值比 = 0.94；95%置信区间：0.40，2.22；p = 0.90）。相比之下，全州数据库发现白人，尤其是白人男性的腹主动脉瘤手术率更高。吸烟和高血压是动脉瘤切除术的强烈危险因素，但糖尿病和社会经济地位不是。在调整其他变量后，动脉瘤切除术的黑人/白人比值比为0.29（95%置信区间：0.07，1.23；p = 0.09）。
在动脉瘤疾病和股动脉粥样硬化闭塞性疾病的危险因素概况中发现了显著差异。糖尿病是股动脉疾病的一个特别强的危险因素，但不是动脉瘤疾病的危险因素。此外，在马萨诸塞州，黑人的股动脉搭桥手术率较高，但明显的种族差异似乎是由于黑人中高血压、吸烟和糖尿病的患病率较高。相比之下，腹主动脉瘤主要发生在白人男性中，调整其他危险因素进一步加剧了白人中更大的风险。
