Keil U, Liese A D, Hense H W, Filipiak B, Döring A, Stieber J, Löwel H
Institute of Epidemiology and Social Medicine, University of Münster, Germany.
Eur Heart J. 1998 Aug;19(8):1197-207. doi: 10.1053/euhj.1998.1089.
The MONICA (Monitoring Trends and Determinants in Cardiovascular Diseases) project in Augsburg provides the first population-based cohort study in Germany to quantify the associations of the risk factors hypertension, hypercholesterolaemia and smoking with incident non-fatal and fatal myocardial infarction and all-cause mortality, and to assess their impact at the population level.
The cohort comprises 1074 men and 1013 women aged 45-64 years; they were followed over 8 years from 1984-1992. In the men, there were 61 non-fatal and fatal myocardial infarctions and 92 all-cause mortality events over this period; in the women the number of deaths from all causes was 45. Incidence rates, hazard rate ratios, population attributable fractions and rate advancement periods were calculated.
Adjusting for confounders, the myocardial infarction hazard rate ratios for men with hypertension, or a total cholesterol/HDL-cholesterol ratio > or =5.5, or smoking > or =20 cigarettes/day, were 2.0 (95% CI 1.2-3.5), 2.9 (95%, CI 1.7-5.0), and 2.7 (95% confidence interval (CI) 1 4-5.0), respectively. The risk factor combination total cholesterol/HDL cholesterol ratio > or = 5.5 and cigarette smoking was particularly hazardous. The three risk factors contributed 65% of the burden of myocardial infarction in the population. The rate advancement period for myocardial infarction associated with hypertension, total cholesterol/HDL cholesterol ratio > or =5.5 or smoking > or =20 cigarettes/day was 8.3, 12.4 and 11.5 years, respectively. In women, these risk factors were similarly predictive of all-cause mortality. Comparing the cohort data from Augsburg with those of two occupational cohorts from Germany reveals higher absolute myocardial infarction risks in the Augsburg population; however, the relative risk estimates in the Augsburg and the two occupational cohorts were very similar.
Our results confirm the important contribution of the classical risk factors to the risk of myocardial infarction and all-cause mortality in Germany. The results pertaining to the concept of rate advancement periods particularly demonstrate the great potential for prevention.
奥格斯堡的MONICA（心血管疾病监测趋势和决定因素）项目是德国首个基于人群的队列研究，旨在量化高血压、高胆固醇血症和吸烟等危险因素与非致命性和致命性心肌梗死及全因死亡率之间的关联，并评估它们在人群层面的影响。
该队列由1074名年龄在45 - 64岁的男性和1013名女性组成；从1984年至1992年对他们进行了8年的随访。在此期间，男性中有61例非致命性和致命性心肌梗死以及92例全因死亡事件；女性的全因死亡人数为45例。计算了发病率、风险率比值、人群归因分数和发病提前期。
在对混杂因素进行调整后，患有高血压、总胆固醇/高密度脂蛋白胆固醇比值≥5.5或每天吸烟≥20支的男性发生心肌梗死的风险率比值分别为2.0（95%可信区间1.2 - 3.5）、2.9（95%可信区间1.7 - 5.0）和2.7（95%可信区间1.4 - 5.0）。总胆固醇/高密度脂蛋白胆固醇比值≥5.5与吸烟这一危险因素组合尤其危险。这三个危险因素占人群中心肌梗死负担的65%。与高血压、总胆固醇/高密度脂蛋白胆固醇比值≥5.5或每天吸烟≥20支相关的心肌梗死发病提前期分别为8.3年、12.4年和11.5年。在女性中，这些危险因素同样可预测全因死亡率。将奥格斯堡的队列数据与德国两个职业队列的数据进行比较发现，奥格斯堡人群中心肌梗死的绝对风险更高；然而，奥格斯堡队列与两个职业队列中的相对风险估计非常相似。
我们的结果证实了经典危险因素对德国心肌梗死风险和全因死亡率的重要贡献。与发病提前期概念相关的结果尤其显示出巨大的预防潜力。
