儿童和青年人心血管多危险因素与动脉粥样硬化之间的关联。博加卢萨心脏研究。

Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study.

作者信息

Berenson G S, Srinivasan S R, Bao W, Newman W P, Tracy R E, Wattigney W A

机构信息

Tulane Center for Cardiovascular Health, Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112-2824, USA.

出版信息

N Engl J Med. 1998 Jun 4;338(23):1650-6. doi: 10.1056/NEJM199806043382302.

DOI:10.1056/NEJM199806043382302

PMID:9614255

Abstract

BACKGROUND

In adults, cardiovascular risk factors reinforce each other in their effect on cardiovascular events. However, information is scant on the relation of multiple risk factors to the extent of asymptomatic atherosclerosis in young people.

METHODS

We performed autopsies on 204 young persons 2 to 39 years of age, who had died from various causes, principally trauma. Data on antemortem risk factors were available for 93 of these persons, who were the focus of this study. We correlated risk factors with the extent of atherosclerosis in the aorta and coronary arteries.

RESULTS

The extent of fatty streaks and fibrous plaques in the aorta and coronary arteries increased with age. The association between fatty streaks and fibrous plaques was much stronger in the coronary arteries (r=0.60, P<0.001) than in the aorta (r=0.23, P=0.03). Among the cardiovascular risk factors, body-mass index, systolic and diastolic blood pressure, and serum concentrations of total cholesterol, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol, as a group, were strongly associated with the extent of lesions in the aorta and coronary arteries (canonical correlation [a measure of the association between groups of variables]: r=0.70; P<0.001). In addition, cigarette smoking increased the percentage of the intimal surface involved with fibrous plaques in the aorta (1.22 percent in smokers vs. 0.12 percent in nonsmokers, P=0.02) and fatty streaks in the coronary vessels (8.27 percent vs. 2.89 percent, P=0.04). The effect of multiple risk factors on the extent of atherosclerosis was quite evident. Subjects with 0, 1, 2, and 3 or 4 risk factors had, respectively, 19.1 percent, 30.3 percent, 37.9 percent, and 35.0 percent of the intimal surface covered with fatty streaks in the aorta (P for trend=0.01). The comparable figures for the coronary arteries were 1.3 percent, 2.5 percent, 7.9 percent, and 11.0 percent, respectively, for fatty streaks (P for trend=0.01) and 0.6 percent, 0.7 percent, 2.4 percent, and 7.2 percent for collagenous fibrous plaques (P for trend=0.003).

CONCLUSIONS

These findings indicate that as the number of cardiovascular risk factors increases, so does the severity of asymptomatic coronary and aortic atherosclerosis in young people.

摘要

背景

在成年人中，心血管危险因素对心血管事件的影响相互强化。然而，关于多种危险因素与年轻人无症状动脉粥样硬化程度之间的关系，相关信息却很少。

方法

我们对204名2至39岁因各种原因（主要是外伤）死亡的年轻人进行了尸检。其中93人有生前危险因素的数据，这些人是本研究的重点对象。我们将危险因素与主动脉和冠状动脉的动脉粥样硬化程度进行了关联分析。

结果

主动脉和冠状动脉中脂肪条纹和纤维斑块的程度随年龄增长而增加。脂肪条纹与纤维斑块之间的关联在冠状动脉中（r = 0.60，P < 0.001）比在主动脉中（r = 0.23，P = 0.03）更强。在心血管危险因素中，体重指数、收缩压和舒张压以及总胆固醇、甘油三酯、低密度脂蛋白胆固醇和高密度脂蛋白胆固醇的血清浓度作为一个整体，与主动脉和冠状动脉病变的程度密切相关（典型相关性[衡量变量组之间关联的指标]：r = 0.70；P < 0.001）。此外，吸烟增加了主动脉中纤维斑块累及内膜表面的百分比（吸烟者为1.22%，非吸烟者为0.12%，P = 0.02）以及冠状动脉中脂肪条纹的百分比（8.27%对2.89%，P = 0.04）。多种危险因素对动脉粥样硬化程度的影响非常明显。有0、1、2和3或4种危险因素的受试者，主动脉中脂肪条纹覆盖内膜表面的比例分别为19.1%、30.3%、37.9%和35.0%（趋势P值 = 0.01）。冠状动脉中脂肪条纹的可比数据分别为1.3%、2.5%、7.9%和11.0%（趋势P值 = 0.01），胶原纤维斑块的可比数据分别为0.6%、0.7%、2.4%和7.2%（趋势P值 = 0.003）。