Natural history of myocardial infarction and angina pectoris in a general population sample of middle-aged men: a 16-year follow-up of the Primary Prevention Study, Göteborg, Sweden

Rosengren A, Wilhelmsen L, Hagman M, Wedel H (Östra University Hospital, Göteborg; Kungälv Hospital, Kungälv; and Nordic School of Public Health, Göteborg, Sweden). Natural history of myocardial infarction and angina pectoris in a general population sample of middle-aged men: a 16-year follow-up of the Primary Prevention Study, Göteborg, Sweden. J Intern Med 1998; 244 : 495–505. Objectives Although many studies have described prognosis in patients with coronary heart disease (CHD), few have compared outcome in men with clinical evidence of CHD with healthy men from the general population over an extended follow-up. This study aimed to compare long-term prognosis in men with a history of myocardial infarction (MI) and in men with angina pectoris (AP) without MI, with men without clinical signs of CHD. Design Longitudinal general population study. Setting City of Göteborg, Sweden. Subjects From a general population sample, 195 men who had survived an MI for 0–19 years (median 3 years) and 314 men with AP but no MI (uncomplicated AP) at baseline in 1974–77 were identified and compared with 6591 men without clinical coronary disease. All were aged 51–59 years. Incident non-fatal and fatal cases occurring until the beginning of 1983 were also followed (n= 317). Main outcome measures Death from CHD, from other causes and from all causes during a follow-up of at least 16 years. Results Overall survival was 72% amongst men without coronary disease, 53% amongst men with uncomplicated AP and 34% amongst men with past MI at baseline. In survivors of MI the risk-factor-adjusted relative risk (RR) of coronary death during follow-up was 6.67 (95% confidence interval (CI) 5.29–8.39), of dying from non-cardiovascular causes 1.35 (0.96–1.91), and of dying from any cause 3.20 (2.67–3.83). During the first 4 years after the baseline examination, the adjusted RR of CHD death was 15.96 (10.29–24.74), and of dying from any cause 5.22 (3.68–7.41). During the last 4 years of follow-up, relative risk was still 5.87 (3.44–10.01) for CHD death and 2.93 (2.05–4.18) for death from any cause. In men with uncomplicated AP, the adjusted relative risk of CHD death during the first 4 years was 4.05 (2.27–7.22) and 3.23 (2.10–4.96) during the last 4-year period. After the first year, the incident MI cases had the same average annual mortality (about 5%) as the prevalent cases. Conclusions In survivors of MI, mortality risk remained high even after an extended follow-up. Men with angina had a better prognosis, but still a compromised survival compared with the general population.     

Serum cholesterol and long-term prognosis in middle-aged men with myocardial infarction and angina pectoris: A 16-year follow-up of the Primary Prevention Study in Gateborg, Sweden

OBJECTIVE: To compare the role of serum cholesterol in the long-term prognosisof men with a history of myocardial infarction, in men withclinical angina without myocardial infarction, and men withoutclinical coronary disease. METHODS: In the second screening of the Primary Prevention Study in Göteborgwhich comprised 7100 men aged 51 to 59 years at baseline in1974–1977, 314 men with clinical angina but no myocardialinfarction at baseline were identified and 195 men who had surviveda myocardial infarction for 0 to 19 years (median 3 years). RESULTS: Of the men without clinical coronary disease at baseline andcholesterol at or below 5·2 mmol .1^–1, 2·7per 1000 observation years died from coronary disease comparedto 8·5 per 1000 of the men with serum cholesterol of7·2 mmol .1^–1 or more. Corresponding figures formen with angina was 5·5 and 31·0 per 1000 observationyears, and for men with prior myocardial infarction 19·8and 58·3 respectively, per 1000. After adjustment forage, smoking, systolic blood pressure, body mass index and diabetesthe risk of coronary death in men with serum cholesterol above7·2 mmol .1^–1 compared to below 5·2 mmol.1^–1 was 2·42 (1·66–3·51) inhealthy men, 4·82 (1·44–16·09) inmen with angina, 2·70 (0·95–7·67)in survivors of myocardial infarction, and 4·07 (1·86–8·91)in the combined group of men with either angina or prior infarction.The strongest effect was seen during the first half of the follow-up,with an adjusted relative risk for high in relation to low serumcholesterol of 8·08 (1·95–33·55)in men with preexisting coronary disease. Non-coronary deathsvaried little by serum cholesterol or coronary disease statusat baseline. After 16 years, 76% of the healthy men with lowcholesterol and 65% of healthy men with cholesterol above 7·2mmol. 1^–1 were still alive. Of the men with prior myocardialinfarction, 50% in the group with low cholesterol were aliveafter 16 years, as compared to 21% of those with high cholesterol. CONCLUSION: The long-term absolute risk of death in men with coronary diseaseand elevated serum cholesterol is very high. Implementationof lipid-lowering strategies shown to be efficacious is importantin this high-risk group.     

Risk factors for angina pectoris in a population study of Swedish men

The Primary Preventive Trial in G?teborg, Sweden, a study of a random population sample of middle-aged men, made it possible to analyse the risk factor pattern cross-sectionally in 166 men with uncomplicated angina pectoris (AP) and compare with 5735 men without angina pectoris or myocardial infarction (MI). A prospective analysis was also performed concerning the risk factor pattern in 128 cases with uncomplicated AP and 34 cases with complicated AP (following an MI) respectively, appearing during a follow-up time of 4 years. At cross-sectional analysis, uncomplicated AP was related to elevated serum cholesterol, elevated systolic and diastolic blood pressure, increased relative body weight, smoking, diabetes mellitus, low physical activity during leisure time, dyspnea and mental stress. However at multivariate, prospective analysis only dyspnea, stress, diabetes mellitus and increased relative body weight were predictors for uncomplicated AP. In contrast, elevated serum cholesterol, high blood pressure, smoking, and high physical activity at work were predictors for complicated AP. Possible reasons for the apparent risk factor differences and different mechanisms in AP and MI are discussed.     

Factors associated with reaching 90 years of age: a study of men born in 1913 in Gothenburg, Sweden

Abstract. Wilhelmsen L, Svärdsudd K, Eriksson H, Rosengren A, Hansson P‐O, Welin C, Odén A, Welin L (Sahlgrenska University Hospital/Östra, Sahlgrenska Academy, University of Gothenburg; Uppsala University, Uppsala; Chalmers University of Technology, Gothenburg; and Lidköping Hospital, Lidköping, Sweden). Factors associated with reaching 90 years of age: a study of men born in 1913 in Gothenburg, Sweden. J Intern Med 2011; 269 : 441–451. Objectives. Increasing numbers of people reach old age. We wanted to identify variables of importance for reaching 90 years old and determine how the predictive ability of these variables might change over time. Setting and subjects. All men in the city of Gothenburg born in 1913 on dates divisible by 3, which is on the 3rd, 6th, 9th etc., were included in the study. Thus, 973 men were invited, and 855 were examined in 1963 at age 50. Further examinations were made at age 54, 60 and 67. Anthropometric data, lifestyle and parental factors, blood pressure, lung function, X‐ray of heart and lungs and maximum work performance were recorded. The area under the receiver operating characteristic curve was used to analyse the predictive capacity of a variable. Results. A total of 111 men (13%) reached 90 years of age, men who reached 90 years were more likely at age 50 to be nonsmokers, consume less coffee, have higher socio‐economic status and have low serum cholesterol levels than those who did not reach this age; however, at age 50 or 62, parents’ survival was of no prognostic importance. Variables of greatest importance at higher ages were low blood pressure and measures related to good cardiorespiratory function. In multivariable analysis, including all examinations, being a nonsmoker, consuming small amounts of coffee, having high housing costs at age 50, good maximum working capacity and low serum cholesterol were related to a better chance of survival to age 90. Conclusions. Low levels of cardiovascular risk factors, high socio‐economic status and good functional capacity, irrespective of parents’ survival, characterize men destined to reach the age of 90.     

Factors influencing the prognosis in patients with angina pectoris. Significance of dynamic coronary occlusion]

Using the results of a prospective follow-up of 106 patients with angina, the authors examined the factors influencing the prognosis of coronary heart disease, including the prognostic value of dynamic coronary occlusion detected during an intravenous ergometrine test. The indicators that are most typical of patients groups with varying outcomes were identified by using the discriminant analysis. The highest value is shown by the factors associated with the extent of coronary occlusion in the prediction of a fatal outcome. A tendency to vasoconstrictive reactions shown as a high sensitivity to ergometrine is a risk factor of myocardial infarction and acute heart failure in individuals highly tolerant to exercise.     

Primary cardiac amyloidosis in a young man presenting with angina pectoris.

A 54 year old man had generalised systemic amyloidosis secondary to bilateral basal bronchiectasis of the lungs. He died after an unexpected asystolic cardiac arrest. Necropsy showed extensive amyloid deposition in the cardiac conduction system.     

One-year prognosis in patients hospitalized with a history of unstable angina pectoris

The prognosis during 1 year of follow-up in 715 patients admitted to one single hospital due to suspected acute myocardial infarction (AMI) with a history of unstable angina pectoris immediately preceding hospitalization is described. AMI developed in 192 patients (27%) during the first three days and in 255 patients (38%) during the first year. The mortality during hospitalization was 7% (50 patients) and during 1 year 19% (130 patients). Of the nonsurvivors, 54% died of AMI, 28% of congestive heart failure, and 20% of cardiogenic shock. Based on simple clinical parameters on admission to the emergency room, risk indicators for death during the following year could be identified as follows, in the order of significance: high age (p < 0.001), ST-segment depression on admission (p < 0.001), and a history of diabetes mellitus (p < 0.05). At admission to the emergency room, risk indicators for development of AMI during the following year were as follows: initial degree of suspicion of AMI (p < 0.001), electrocardiographic signs of acute ischemia on admission (p < 0.001), ST-segment elevation on admission (p < 0.01), age (p < 0.05), and lack of a previous history of chronic stable angina pectoris (p < 0.05). We conclude that, among patients admitted to hospital due to suspected AMI with a history of unstable angina pectoris immediately preceding hospitalization, 38% developed a confirmed infarction and 19% died during the following year.     

The prognostic importance of asymptomatic ischemic episodes in patients with unstable angina pectoris

Unstable angina pectoris is a high-risk ischemic disease which is characterized by recent onset of angina, a change in preexisting stable angina pattern or the occurrence of angina at rest. In a study of 70 patients with unstable angina on treatment with a triple drug regimen of nitrates, propranolol and nifedipine, 37 patients (53%) had 205 ischemic episodes, 90% of which were asymptomatic. 33 patients (47%) had no changes in the ST-segments. Between the two groups, there were no significant differences with respect to risk factors, medical treatment or coronary angiographic findings. Only the resting ejection fraction in the former group was slightly but significantly lower than in the latter group. At one month of follow-up seven patients had developed myocardial infarction, six of whom were in the group with silent ischemia. In 13 patients, due to inadequate success of medical treatment, bypass surgery or PTCA was performed; ten of these were from the group with silent ischemia. Of patients with silent ischemia, those with episodes totaling more than 60 minutes per 24 hours had the worst outcome. Multivariate analysis showed that, with respect to prognosis, the most important parameter was silent ischemia followed by angina pectoris.     

Declining prevalence of angina pectoris in middle-aged men and women. A population-based study within the Northern Sweden MONICA Project

Abstract. Glader E-L, Stegmayr B (University Hospital, Umeå, Sweden). Declining prevalence of angina pectoris in middle-aged men and women. A population-based study within the Northern Sweden MONICA Project. J Intern Med 1999; 246 : 285–291. Objectives. To describe trends in the prevalence of angina pectoris in northern Sweden, between 1986 and 1994. Design. Cross-sectional population studies. Setting. Northern Sweden MONICA Project in Norrbotten and Västerbotten counties, Sweden. Subjects. Randomly selected men and women in the age group 35–64 years, total of 2459 men and women. Main outcome measures. Comparison of the prevalence of angina pectoris in 1986 and 1994 as measured by the Rose questionnaire. Results. The proportion with a history of myocardial infarction decreased amongst the participants from 4.6% to 2.0% (P < 0.001) between 1986 and 1994. The prevalence of angina pectoris in men was essentially unchanged (3.4% in 1986 to 3.1% in 1994 (χ² = 0.02; P = 0.87), whereas it declined significantly in women from 5.9% to 2.8% (χ² = 6.32; P = 0.01). In both men and women, the highest prevalence of Rose-positive persons was found in the oldest age group. In 1986 the Rose-positive subgroup had a significantly higher proportion with high cholesterol (≥6.5 mmol L^–1) as compared with the Rose-negative subgroup, 64% vs. 48% (χ² = 5.04; P = 0.02). In both surveys high blood pressure was more common in the Rose-positive group (1986: χ² = 13.2; P < 0.001 and 1994: χ² = 9.8; P = 0.002). Conclusions. In women, but not in men, the prevalence of angina pectoris decreased significantly between 1986 and 1994. During the same time period the proportion of people with high cholesterol decreased in northern Sweden. In both surveys, individuals with angina pectoris had more frequent hypertension.     

Prognosis for women with different symptoms and signs suggesting ischaemic heart disease--a 12-year follow-up. The population study of women in Gothenburg, Sweden

A longitudinal population study of a total of 1462 women aged 38-60 was carried out in 1968-69 in Gothenburg, Sweden. The women have been re-studied in 1974-75 and 1980-81. The incidences of myocardial infarction during the following 12-year period were: three of 29 women with a history of angina pectoris (10%), four of 23 women with initial ECG changes at rest (17%) and one of 30 with ECG changes during work (3%). In addition, all women of similar age in Gothenburg with myocardial infarction during the years 1968-70 have been followed-up with respect to mortality, and in all there were 47 women who were alive on arrival at hospital. The figures for the 12-year overall mortality in the population study were: three women with angina pectoris (10%), four women with ECG changes at rest (17%) and three women with ECG changes during work (10%) and in the series of women with myocardial infarction 21 of 47 (45%). It seemed that the mortality among women with a history of angina pectoris or ECG changes at rest or during exercise indicating ischaemic heart disease was only slightly increased, if at all, compared to other women in the population, while having had a myocardial infarction significantly increased the mortality risk.     

The J-shaped relationship between coronary heart disease and achieved blood pressure level in treated hypertension: further analyses of 12 years of follow-up of treated hypertensives in the Primary Prevention Trial in Gothenburg, Sweden

The relationship between the blood pressure level achieved through antihypertensive treatment and the incidence of coronary heart disease (CHD) was studied in 686 middle-aged hypertensive men. The patients studied came from a random population sample and were followed-up for 12 years, yielding a total of 6563 patient-years for the study. Eighty-seven patients suffered a non-fatal myocardial infarction or died from CHD. The incidence of CHD showed a J-shaped distribution in relation to achieved treated systolic and diastolic blood pressure levels. The incidence of CHD, adjusted for entry characteristics, age, serum cholesterol, blood pressure and smoking habits, decreased with reductions in blood pressure achieved through treatment, to a level of about 150/85 mmHg, below which the incidence rate again increased. This J-shaped pattern was also observed when data from patients with pre-existing signs or symptoms of ischemic heart disease at entry were excluded. Using a quadratic term as the best fit to the observed relationship between achieved treated diastolic blood pressure level and the incidence of CHD, a Cox regression analysis showed that the nadir of the J-shaped incidence curve was at a diastolic blood pressure value of 81 mmHg. There did not seem to be any association between the absolute size of the blood pressure reduction during treatment and the incidence of CHD. Although we cannot exclude the possibility that the increased incidence of CHD in patients with a low treated blood pressure is due primarily to pre-existing but subclinical ischemic heart disease, our findings indicate that an excessive lowering of blood pressure in hypertensive patients may be harmful.(ABSTRACT TRUNCATED AT 250 WORDS)     

Body mass, fat-free body mass, and prognosis in patients with chronic obstructive pulmonary disease from a random population sample: findings from the Copenhagen City Heart Study

RATIONALE: Low body mass index (BMI) is a marker of poor prognosis in chronic obstructive pulmonary disease (COPD). In the general population, the harmful effect of low BMI is due to the deleterious effects of a low fat-free mass index (FFMI; fat-free mass/weight(2)). OBJECTIVES: We explored distribution of low FFMI and its association with prognosis in a population-based cohort of patients with COPD. METHODS: We used data on 1,898 patients with COPD identified in a population-based epidemiologic study in Copenhagen. FFM was measured using bioelectrical impedance analysis. Patients were followed up for a mean of 7 yr and the association between BMI and FFMI and mortality was examined taking age, sex, smoking, and lung function into account. MAIN RESULTS: The mean FFMI was 16.0 kg/m(2) for women and 18.7 kg/m(2) for men. Among subjects with normal BMI, 26.1% had an FFMI lower than the lowest 10th percentile of the general population. BMI and FFMI were significant predictors of mortality, independent of relevant covariates. Being in the lowest 10th percentile of the general population for FFMI was associated with a hazard ratio of 1.5 (95% confidence interval, 1.2-1.8) for overall mortality and 2.4 (1.4-4.0) for COPD-related mortality. FFMI was also a predictor of overall mortality when analyses were restricted to subjects with normal BMI. CONCLUSIONS: FFMI provides information in addition to BMI and assessment of FFM should be considered in the routine assessment of COPD.     

The impact of diabetes or elevated fasting blood glucose on cardiovascular prognosis in patients with stable angina pectoris.

AIMS: To examine the influences of diabetes and elevated fasting blood glucose on cardiovascular prognosis in patients with stable angina pectoris. METHODS: In a prospective study of 809 patients with stable angina pectoris randomized to receive metoprolol or verapamil, a subgroup of 69 diabetic patients was compared with non-diabetic patients with respect to the risk of cardiovascular (CV) death, non-fatal myocardial infarction (MI) and revascularization. We also analysed a subgroup of 67 patients with fasting blood glucose > or = 6.1 mmol/l, defined according to the most recent revised guidelines for the diagnosis of diabetes mellitus. Fasting blood glucose was measured in venous whole blood at baseline. RESULTS: The diabetic patients had a greater risk-factor burden, with a higher prevalence of hypertension, more likely to be male, a tendency towards a higher prevalence of previous MI, and higher triglyceride and lower high-density lipoprotein (HDL)-cholesterol levels. In multivariate analyses, diabetes was an independent risk factor for CV events with a relative risk of 2.64 (CI 1.39-5.00; P < 0.001) for CV death/MI, and 1.79 (CI 1.02-3.15; P < 0.01) for revascularization. Blood glucose > or = 6.1 mmol/l without a diagnosis of diabetes mellitus was found in 67 patients, and predicted CV death/MI [relative risk 2.76 (CI 1.97-3.84)] in both univariate and multivariate analyses. The prognosis of diabetic or hyperglycaemic patients did not differ significantly with metoprolol compared with verapamil treatment. CONCLUSIONS: Diabetes mellitus is an independent risk factor for CV death/MI and for revascularization in patients with stable angina pectoris. Elevated fasting blood glucose was seen in 9% of patients without known diabetes and was an equally strong and independent risk factor for CV death/MI as diagnosed and treated diabetes.     

不稳定型心绞痛患者血浆脑钠肽、肌钙蛋白I、高敏C反应蛋白水平对近期预后的影响

目的探讨不稳定型心绞痛（uA）患者血浆脑钠肽（BNP）、肌钙蛋白I（cTnI）和高敏C反应蛋白（hs-CRP）水平对近期预后的价值。方法按Braunwald标准,120例心功能正常的UA患者分为IB组（35例）、ⅡB组（42例）及ⅢB组（43例）,并取50例稳定型心绞痛（SAP）患者作为对照组。SAP组与UA组于人院24h内及入院后24h抽肘前静脉血2次,分别行BNP、cTnI和hs—CRP检测,取两次结果的最高值,并择期行冠状动脉造影检查。随访30d内主要不良心脏事件（MACE）。结果①UA组BNP、cTnI、hs—CRP均显著高于对照组（P均〈0．05）;ⅢB组的BNP[96．3（79．8～100．1）]、cTnI（0．078±0．022）和hs—CRP（9．68±1．95）显著高于IB组和ⅡB组[ⅠB组BNP50．0（32．6±58．8）、Tnl（0．018±0．06）、hs—CRP（4．88±1．83）;ⅡB组BNP90．6（69．6～95．8）、Tnl（0．042±0．010）、hs—CRP（5．72±2．08）,P均〈0．05]。②冠脉三支病变组的BNP（99．65±19．73）与双支病变组的BNP（48．54±10．79）明显高于单支病变组（30．37±8．52）。三支病变组的BNP、cTnI明显高于双支及单支病变组,组间比较差异有统计学意义（P均〈0．05）。③观察4周,uA组心脏事件发生率明显高于SAP组（16％比2％,P〈0．05）。Logistic回归分析显示,BNP、cTnI和hs—CRP是30dMACE的独立预测因素。结论血浆BNP、cTnI和hs—CRP水平对临床评价UA患者病情程度及近期预后有重要价值。     

Primary angina pectoris: significance of clinical, bicycle ergometric and coronarographic data in the prognosis of ischemic heart disease remission

By the first year of a follow-up, spontaneous clinical remissions (no anginal and ischemic episodes as evidenced by Holter monitoring, negative bicycle ergometric tests) in 52 (26%) out of 200 patients with primary angina pectoris. Possible predictors such as clinical signs, bicycle ergometric and coronary angiographic parameters were examined. A multifactorial stepwise discriminant analysis showed that the independent predictors of the clinical remission were heart rate and exercise power attained on bicycle ergometry, number of diseased coronary artery segments with 70% of more stenoses, disease pattern in the first month, existing and prior smoking, and myocardial infarction in the first 3 months of the disease onset.     

Bundle-branch block in middle-aged men: risk of complications and death over 28 years. The Primary Prevention Study in G?teborg, Sweden.

AIMS: To investigate the long-term fate of men with bundle-branch block (BBB) from a general population sample. METHODS AND RESULTS: Data were derived from 7392 men without a history of myocardial infarction or stroke, born between 1915 and 1925 and investigated between 1970 and 1973. All participants were followed from the date of their baseline examination until 1998. We identified 70 men with right-BBB and 46 men with left-BBB at baseline. In men with right-BBB, there was no increased risk of myocardial infarction, coronary death, heart failure, or all-cause mortality during follow-up. The multiple-adjusted hazard ratio for progression to high-degree atrioventricular block was 3.64 (99% confidence interval 0.79-16.72). In men with left-BBB, the hazard ratio for high-degree atrioventricular block was 12.89 (4.13-40.24). However, hazard ratio for all-cause mortality was 1.85 (1.15-2.97) when compared with men without BBB, mostly due to outside hospital coronary deaths, whose hazard ratio was 4.22 (1.90-9.34). CONCLUSION: The presence of BBB was strongly associated with future high-degree atrioventricular block that was more pronounced for left-BBB. Men with left-BBB have a substantially increased risk of coronary death, mainly due to sudden death outside the hospital setting.     

Adiposity and adipose tissue distribution in relation to incidence of diabetes in women: results from a prospective population study in Gothenburg, Sweden

The results refer to a 12-year longitudinal population study of women in Gothenburg, Sweden. Correlations were studied between initial adipose tissue amount and adipose tissue distribution on the one hand and incidence of diabetes and change in serum blood glucose concentration on the other. Body mass index, sum of two skinfolds and waist-to-hip circumference ratio were significantly associated with incidence of diabetes. The waist-to-hip ratio was also positively associated with an increase of serum glucose concentration in the fasting state during the followup period. The significant correlations remained in multivariate analysis and were independent of age, initial smoking habits, systolic blood pressure, intake of antihypertensive drugs and serum cholesterol, triglyceride and glucose concentrations. The correlations between the separate anthropometric variables and incidence of diabetes remained when the other anthropometric variables were considered as background factors. The distribution of fat to the abdominal region as well as the total amount of fat per se seem to be important risk factors for diabetes and the effect of one of these factors seems to add to the other.     

老年稳定性心绞痛患者循环微RNA-92a表达的影响因素研究

目的了解循环微RNA(miR)-92a在老年稳定性心绞痛(SAP)患者中的表达。方法选择SAP患者116例,分为老年组(年龄≥60岁)66例,非老年组(年龄<60岁)50例。比较老年SAP患者循环miR-92a表达,方差成分分析2组患者一般临床资料及其交互效应项对SAP患者循环miR-92a表达的贡献。比较2组合并及未合并糖尿病患者循环miR-92a表达。结果 SAP患者年龄与循环miR-92a表达呈正相关(相关系数0.21 7,P<0.05)。老年组循环miR-92a表达明显高于非老年组(P=0.056)。方差成分分析显示,年龄、糖尿病影响SAP循环miR-92a表达。老年组合并糖尿患者循环miR-92a表达明显高于未合并糖尿病患者(P<0.01).非老年组合并糖尿病患者循环miR-92a表达明显高于未合并糖尿病患者(P<0.05)。老年组合并糖尿病发生率33.3%明显高于非老年组16.0%(P<0.05)。结论老年患者循环miR-92a表达升高不是年龄升高所致。提示老年SAP患者循环miR-92a表达升高要特别注意引发血管内皮损伤的糖尿病。