Wannamethee S G, Shaper A G, Walker M, Ebrahim S
Department of Primary Care and Population Sciences, Royal Free Hospital School of Medicine, London, England.
Arch Intern Med. 1998;158(22):2433-40. doi: 10.1001/archinte.158.22.2433.
To examine the relationship between modifiable lifestyle factors (smoking, physical activity, alcohol intake, and body mass index [BMI]) and the likelihood of 15-year survival free of major cardiovascular end points and diabetes in middle-aged men.
A prospective study of 7142 men aged 40 to 59 years at screening with no history of coronary heart disease, diabetes, and stroke drawn from 1 general practice in each of 24 British towns and followed up for 15 years.
Death from any cause and a combined end point, including survival free of heart attacks or stroke or the development of diabetes over a follow-up of 15 years for each man.
During the 15-year follow-up, there were 1064 deaths from all causes, 770 major heart attacks (fatal and nonfatal), 247 stroke events (fatal and nonfatal), and 252 cases of diabetes among the 7142 men. After adjustment for age and each of the other modifiable lifestyle factors, the risk of the combined end point (death or having a heart attack, stroke, or diabetes) went up significantly with increasing smoking levels and from BMI levels of 26 kg/m2 or higher, and decreased significantly with increasing levels of physical activity up to levels of moderate activity with no further benefit thereafter (heavy smoking vs never: relative risk [RR] [odds], 2.50; 95% confidence interval [CI], 2.12-2.94; BMI > or = 30 vs 20-21.9 kg/m2: RR, 2.11; 95% CI, 1.71-2.62; moderate vs inactive: RR, 0.60; 95% CI, 0.50-0.72). Light drinking (vs occasional) showed a relatively small but significant reduction in risk (RR, 0.84; 95% CI, 0.74-0.96). Using Cox predictive survival models, the estimated probability of surviving 15 years free of cardiovascular events and diabetes in a man aged 50 years ranged from 89% in a moderately active man at BMI levels of 20 to 24.0 kg/m2 who had never smoked to 42% in an inactive smoker with BMI level of 30 kg/m2 or higher.
Modifiable lifestyles (smoking, physical activity, and BMI) in middle-aged men play an important role in long-term survival free of cardiovascular disease and diabetes. These findings should provide encouragement for public health promotion directed toward middle-aged men.
探讨可改变的生活方式因素（吸烟、体育活动、饮酒及体重指数[BMI]）与中年男性15年无主要心血管终点事件和糖尿病存活可能性之间的关系。
对来自英国24个城镇中每个城镇1家全科诊所的7142名年龄在40至59岁之间、筛查时无冠心病、糖尿病和中风病史的男性进行前瞻性研究，并随访15年。
各种原因导致的死亡以及一个综合终点，包括每位男性在15年随访期间无心脏病发作或中风存活以及未患糖尿病。
在15年随访期间，7142名男性中共有1064例各种原因导致的死亡、770例主要心脏病发作（致命和非致命）、247例中风事件（致命和非致命）以及252例糖尿病病例。在对年龄和其他可改变的生活方式因素进行调整后，综合终点（死亡或发生心脏病发作、中风或糖尿病）的风险随着吸烟量增加以及BMI水平达到26kg/m2或更高而显著上升，随着体育活动量增加至中等活动水平而显著下降，此后不再有进一步益处（重度吸烟与从不吸烟相比：相对风险[RR][比值比]，2.50；95%置信区间[CI]，2.12 - 2.94；BMI≥30与20 - 21.9kg/m2相比：RR，2.11；95%CI，1.71 - 2.62；中等活动与不活动相比：RR，0.60；95%CI，0.50 - 0.72）。轻度饮酒（与偶尔饮酒相比）显示风险有相对较小但显著的降低（RR，0.84；95%CI，0.74 - 0.96）。使用Cox预测生存模型，一名50岁男性15年无心血管事件和糖尿病存活的估计概率范围从BMI水平为20至24.0kg/m2、从不吸烟的中等活动男性的89%到BMI水平为30kg/m2或更高的不活动吸烟者的42%。
中年男性可改变的生活方式（吸烟、体育活动和BMI）在无心血管疾病和糖尿病的长期存活中起重要作用。这些发现应为针对中年男性的公共卫生促进提供鼓励。
