中国11省市队列人群危险因素与不同类型心血管病发病危险的比较

目的描述在中国35—64岁人群中,不同类型心血管病（包括急性冠心病事件、急性缺血性脑卒中和出血性脑卒中事件）发病的特点。比较传统心血管病危险因素与冠心病和脑卒中（急性缺血性脑卒中和出血性脑卒中事件）发病危险的关系。方法以中国多省市前瞻性队列研究的数据为基础,该队列由1992年建立的11省市35～64岁27249人和1996年到1999年又加入的3129人所组成,共30378人。本研究基线危险因素水平和1992--2003年期间发生的心血管病（包括冠心病和脑卒中）事件的关系进行分析。结果（1）急性冠心病事件、急性缺血性脑卒中事件和急性出血性脑卒中事件的累积人年发病率分别为114／100000、209／100000和73／100000。（2）随访期间发生心血管病的亚组人群基线时有84％～89％的人伴有1个或1个以上的心血管病危险因素,高于无心血管病的亚组人群（64．7％,P〈0．01）。（3）危险因素对不同类型心血管病发病的影响及作用强度有所差别：对冠心病发病危险的影响因素根据强度依次为高血压、吸烟、高胆固醇血症和低高密度脂蛋白胆固醇血症;对缺血性脑卒中发病危险的影响因素依次为高血压、糖尿病、低高密度脂蛋白胆固醇血症、吸烟和肥胖;对出血性脑卒中发病危险的独立影响因素只有高血压。结论在心血管病的主要危险因素中,不同的危险因素对不同类型的心血管病发病危险的作用存在差别。我国人群不同危险因素的变化趋势将影响不同类型心血管。     

中国11省市队列人群基线血压和7年累积心血管病发病危险的前瞻性研究

目的：以较大人群、较广的地理覆盖面的前瞻性队列研究结果提供中国人血压水平与心血管病发病危险最化关系的数据;探讨收缩压和舒张压作为危险因素标识或致病因素在与心血管病的发病危险的关系上存在的差别;分析血压对急性脑卒中和冠心病事件发病的影响是否存在差别及控制血压对预防这两种疾病的公共卫生意义;初步评价现行的高血压诊断、治疗和分级标准。方法：对1992年建立的11省市35－64岁队列人群共29488人基线血压水平和1992－1999年共138177．1观察人年中生心血管病（包括脑卒中和冠心病）事件发病的数据进行单因素和多因素分析。结果：对收缩压和舒张压分别进行的单因素和多因素分析显示,两均可作为预测生心血管病事件发病危险的有效标识,但收缩压水平对急性心血管病事件,特别是脑卒中危险的影响强度明显大于舒张压,收缩压≥180mmHg（1mmHg=0.133kPa)组与收缩压＜120mmHg组人群相比,生心血管事件发病危险单因素分析时高22倍（脑座中31倍,冠心病8倍）,多因素分析时高11倍（脑卒中16倍,冠心病4倍）。血压对于与急性脑卒中事件和急性冠心病事件的影响无论在强度、影响方式和预防的公共卫生意义上存在明显差别,人群中79．7％的脑卒中事件可归因于血压的升高,但只有36．6％的冠心病事件可归因于血压的增高因血压各分级中,心血管事件的发病危险随其他危险因素存在的数量而上升。结论：高血压是目前中国人群最重要的心血管病危险因素,有效的防治高血压是减少我国心血管病负担最重要和最关键的环节。     

父母高血压史与心血管病发病关系的前瞻性研究

目的探讨我国人群中父母高血压史与子代心血管病发病的关系。方法1992—1994年在全国12组人群中分别整群随机抽取1000—2000人进行心血管病危险因素调查,并对心血管事件的发生情况进行随访观察,随访至2005年6月,平均随访10．8年。结果15131例随访对象共发生心血管事件448例,其中冠心病事件82例,脑卒中事件370例,4例既发生冠心病事件又发生脑卒中事件。在控制了年龄、吸烟、饮酒后,男性和女性父母双方均无高血压史者、仅父母一方有高血压史者、父母双方均有高血压史者发生心血管病的相对危险分别为：男性：1．00,1．34（1．01—1．78）,2．58（1．62—4．11）;女性：1．00,1．77（1．27—2．45）,2．55（1．44—4．54）。在进一步控制了总胆固醇、高密度脂蛋白胆固醇、空腹血糖、体重指数和收缩压后,男性和女性上述各组发生心血管病的相对危险分别为：男性：1．00,1．01（0．76—1．35）,1．72（1．07—2．75）;女性：1．00,1．31（0．94—1．84）,1．76（0．98—3．15）。结论父母有高血压史者具有较高的发生心血管病的危险性,父母双方均有高血压史者心血管病发病危险的增加尤为显著。遗传因素对子代的影响在很大程度上是通过我们目前已知的危险因素而起作用。因而父母有高血压史者强化对传统的危险因素的控制,对于预防心血管病发病、提高生活质量可能具有更重要的意义。     

金坛市乡镇人群脑卒中危险因素比例风险模型

目的：通过对金坛市两乡镇队列人群的监测和生存分析，寻找农村人群脑卒中发病和死亡的危险因素，为社区干预提供依据。方法：以1984、1992年金坛市心血管病监测点社头、河头两乡镇的基线调查人群为队列，经过多年随访，采用Cox回归生存分析方法进行分析。结果：队列随访结果表明，脑卒中的发病率为180．20／10万人年，其中男性发病率为236．22／10万人年，女性发病率为133．99／10万人年；脑卒中的死亡率为106．79／10万人年。全死因死亡率为767．53／10万人年，其中男性为1018．68／10万人年，女性为560．32／10万人年。结论：总的多因素Cox回归模型中，脑卒中发病与脑卒中史、母亲高血压史、收缩压、年龄有关；分性别Cox回归模型中，男性脑卒中发病与收缩压、年龄、家族史（母亲患高血压）、体重指数、吸烟史有关；女性脑卒中发病与收缩压、年龄、脑卒中史、高血压史、高密度脂蛋白胆固醇有关。     

中国35～64岁人群胆固醇水平与10年心血管病发病危险的前瞻性研究

目的探讨我国35～64岁人群血清总胆固醇（TC）水平与心血管病（包括急性冠心病事件和急性脑卒中事件）发病危险的关系。方法采用前瞻性队列研究的方法,对1992年建立的11省市35—64岁队列人群共30384人的基线TC水平和1992-2002年发生的急性冠心病事件和急性脑卒中事件的关系进行分析。应用Cox比例风险模型对TC水平与心血管病发病危险进行多因素分析。结果（1）以TC〈3．64mmol／L（140mg／d1）组为对照,随着TC水平的增加,缺血性心血管病发病危险呈持续增加变化。（2）TC水平与不同类型的心血管病的关系有所差别：缺血性脑卒中事件发病危险从TC很低水平（〈3．64mmol／L）开始,随着TC水平的增加呈持续上升的变化;而出血性脑卒中事件与TC水平的关系缺乏一致性。多因素分析结果显示：与TC〈5．72mmol／L（220mg／d1）相比,TC≥5．72mmol／L时急性冠心病发病危险增加74％（RR=1．743,P〈0．01）,缺血性脑卒中发病危险增加12％（RR=1．119,P〉0．05）。（3）在缺血性心血管病事件中,5．9％可归因于高TC血症;其中11．7％的急性冠心病事件和2．9％的急性缺血性脑卒中事件可归因于高TC血症。（4）不同TC水平时,随着合并其他心血管病危险因素个数的增加,10年心血管病发病的绝对危险增加。结论从TC低水平〈3．64mmol／L（140mg／dl）开始,随着TC水平的增加缺血性心血管病的发病危险持续上升。应该加强多重危险因素的综合干预,以减少心血管病的综合危险。     

空腹血糖受损新标准对其患病率和缺血性心血管病发病危险的影响

目的评价2003年美国糖尿病协会新的空腹血糖受损标准对中国35～64岁人群空腹血糖受损率的影响以及与缺血性心血管病发病危险的关系。方法以中国多省市前瞻性队列研究的数据为基础,对30378人基线血糖水平的分布特点以及10年随访期间发生的缺血性心血管病（包括冠心病和缺血性脑卒中）事件关系进行分析。结果（1）依据新的空腹血糖受损的标准,我国35～64岁人群空腹血糖受损率从6．9％上升到21．6％,增加了2.1倍;（2）按基线血糖水平分为4个亚组,随着血糖水平的升高,其他传统心血管病危险因素的比例增加;（3）缺血性心血管病人年发病率和血糖单因素分析显示,随着血糖水平的增加男女两性缺血性心血管病发病危险增加,并达到统计学意义;（4）多因素分析显示,在调整了其他传统的心血管病危险因素后,空腹血糖受损新的标准（由6．11mmol／L降为〈5．55mmol／L）对男性缺血性心血管病有独立的影响作用（RR=1．302,95％CI=1．021～1．660）;对女性缺血性心血管病发病危险缺乏独立的影响作用（RR=1．255,95％CI=0．887～1．776）。结论依据新标准中国35～64岁人群空腹血糖受损率增加了2倍以上。随着血糖水平的增加伴有其他传统的危险因素的比例及缺血性心血管病的人年发病率增加,多因素分析后空腹血糖受损新切点增加男性缺血性心血管病发病的危险。     

50岁时危险因子对终生心血管病的预警意义

治疗危险因子，预防心血管病应当及早进行。50岁以前的人很少有心血管病，但是可能已经有危险因子。过去评估这些危险因子对心血管病的影响，都只研究10年内有多少百分数发生心血管病（CVD），这种做法对中年人来说评估时间太短（Circulation，2006，113：791-998）。该文报道参加Framingham研究，50岁时没有心血管病的3564名男性与4362名女性，在111777人年的随访期间，有1757人患CVD（心肌梗死、冠心病死亡、心绞痛、缺血性脑中风、间歇性跛行），1641名因CVD死亡。研究计算出50岁的人假如男的再活30年，女的再活36年，52％的男性及40％女性会得CVD。     

顺德市容桂地区中年农业人群心血管病危险因素探讨

目的：探讨顺德容桂地区农业人群心血管病的危险因素。方法：1997－1999年对本地区小黄圃等6个村委会35－39岁有农业户口的常住人群共4083名人员作为调查对象，进行病史询问以及血压，身高，体重，腰围，臀围、血糖、血脂、心电图等检查。结果：高血压患病率为14．8％（标化率），血脂异常率41．3％，超重率20．8％，饮酒率36．7％；现在吸烟率男性58．4％，女性4．7％。结论：本地区中年农业人群多项心血管病危险因素水平较高，特别要注意腰臀比、体重指数，血脂、血糖指标测定，应予重视并进行干预，以期降低心血管疾病的发病率及死亡率。     

北京地区急性冠心病事件死亡率1984～1993年变化趋势及影响因素的探讨

在北京地区70万自然人群中，对急性冠心病事件的死亡率及有关的危险因素进行了十年（1984～1993）监测。其结果显示：35～74岁男性年平均冠心病死亡率，90．1／10万，女性死亡率为53．9／10万；1993年死亡率比1984年男性增高17％，女性增高56％。1993年比1984年男性发病率增高36％，女性增高66％。同时期三次（1984~1985，1988～1989，1993年）在监测人群中进行心血管危险因素抽样调查，结果显示：第三次与第一次相比男性吸烟率增长25％；男女两性平均收缩压均增长0．133kPa（1mmHg）（0．8％）；平均总胆固醇水平男性上升11．2mg％（7．0％），女性上升7mp％（4．4％）。本研究提示：北京地区急性冠心病死亡率呈持续上升趋势，这种趋势推测主要受发病率上升的影响，人群中冠心病危险因素水平的增加是影响发病率上升的重要原因。     

影响老年冠心病患者血运重建术后死亡的危险因素

目的了解影响老年冠心病患者血运重建术后死亡的危险因素。方法在药物洗脱支架对血运重建影响研究（DESIRE）数据库中,人选2003年7月1日至2004年6月30日在我院接受冠状动脉血运重建术,年龄70岁以上,出院后随访〉30天的冠心病患者675例,男性498例,女性177例。记录患者的临床特点、随访期间死亡和主要不良心脑血管事件（MACCE）发生情况。结果平均随访（754±355）天。随访中死亡27例（4．0％）,发生MACCE50例（7．4％）,多因素Cox回归分析,校正其他因素后,与男性患者相比,女性患者死亡的危险为2．750（95％CI1．116—6．779,P=0．028）;合并贫血患者死亡危险为0．385（95％C10．164—0．904,P=0．028）;血肌酐（Cr）水平越高,死亡危险越大,肾功能减低者（Cr≥115μmol／L）死亡危险为2．963（95％ CI1．114～9．952．P=0．035）,肾功能不全者（Cry〉177μmol／L）死亡危险为10．785（95％CI 2．659～78．097,P=0．000）。结论影响血运重建后老年冠心病患者死亡的危险因素是性别、血运重建前血红蛋白和Cr水平。女性、贫血和肾功能减低的冠心病患者血运重建后远期预后不良,死亡率高。术前应认识这些危险因素并加以纠正,将有利于改善血运重建后老年冠心病患者的远期预后。     

Vitamin supplement use in a low-risk population of US male physicians and subsequent cardiovascular mortality

BACKGROUND: Although basic research suggests that vitamins may have an important role in the prevention of cardiovascular diseases (CVD), the data from cohort studies and clinical trials are inconclusive. METHODS: This prospective cohort study was conducted among 83 639 male physicians residing in the United States who had no history of CVD or cancer. At baseline, data on use of vitamin E, ascorbic acid (vitamin C), and multivitamin supplements were provided by a self-administered questionnaire. Mortality from CVD and coronary heart disease (CHD) was assessed by death certificate review. RESULTS: Use of supplements was reported by 29% of the participants. During a mean follow-up of 5.5 years, 1037 CVD deaths occurred, including 608 CHD deaths. After adjustment for several cardiovascular risk factors, supplement use was not significantly associated with total CVD or CHD mortality. For vitamin E use, the relative risks (RRs) were 0.92 (95% confidence interval [CI], 0.70-1.21) for total CVD mortality and 0.88 (95% CI, 0.61-1.27) for CHD mortality; for use of vitamin C, the RRs were 0.88 (95% CI, 0.70-1.12) for total CVD mortality and 0.86 (95% CI, 0.63-1.18) for CHD mortality; and for use of multivitamin supplements, the RRs were 1.07 (95% CI, 0.91-1.25) for total CVD mortality and 1.02 (95% CI, 0.83-1.25) for CHD mortality. CONCLUSIONS: In this large cohort of apparently healthy US male physicians, self-selected supplementation with vitamin E, vitamin C, or multivitamins was not associated with a significant decrease in total CVD or CHD mortality. Data from ongoing large randomized trials will be necessary to definitely establish small potential benefits of vitamin supplements on subsequent cardiovascular risk.     

Lifetime risk of cardiovascular disease and life expectancy with and without cardiovascular disease according to changes in metabolic syndrome status

Background and aimsThe relationship between dynamic changes in metabolic syndrome (MetS) status and lifetime risk of cardiovascular disease (CVD) has not been reliably quantified. This study aimed to estimate lifetime risk of CVD and life expectancy with and without CVD according to dynamic MetS status.Methods and ResultsDynamic changes in MetS status were assessed: MetS-free, MetS-chronic, MetS-developed, and MetS-recovery groups. We used Modified Kaplan–Meier method to estimate lifetime risk and used multistate life table method to calculate life expectancy. Participants free of CVD at index ages 35 (n = 40 168), 45 (n = 33 569), and 55 (n = 18 546) years. At index age 35 years, we recorded 1341 CVD events during a median follow-up of 6.1 years. Lifetime risk of 33.9% (95% CI: 26.9%–41.0%) in MetS-recovery group was lower than that of 39.4% (95% CI: 36.1%–42.8%) in MetS-chronic group. Lifetime risk of 37.8% (95% CI: 30.6%–45.1%) in MetS-developed group was higher than that of 26.4% (95% CI: 22.7%–30.0%) in MetS-free group. At index age 35 years, life expectancy free of CVD for MetS-recovery group (44.1 years) was higher than that for MetS-chronic group (38.8 years). Life expectancy free of CVD for MetS-developed group (41.9 years) was lower than that for MetS-free group (46.7 years).ConclusionsRecovery from MetS was associated with decreased lifetime risk of CVD and a longer life expectancy free of CVD, whereas development of MetS was associated with increased lifetime risk of CVD and a shorter life expectancy free of CVD.     

Risk factors for primary prevention of cardiovascular disease and risk reduction by lipid control: the OMEGA study risk factor sub-analysis

To identify risk factors for cardiovascular disease (CVD) in hypertensive patients with no history of CVD being treated with antihypertensive drugs, we examined subgroup data (n?=?13?052) from the prospective, observational Olmesartan Mega Study to Determine the Relationship between Cardiovascular Endpoints and Blood Pressure Goal Achievement (OMEGA) study. Risk factors for CVD, stroke and coronary heart disease (CHD) were examined using a Cox proportional hazards model. In addition, the effect of statin therapy at baseline on CHD prevention was analyzed in dyslipidemic patients. The factors significantly related to CVD were female (hazard ratio [HR]?=?0.637, 95% confidence interval [CI] 0.428–0.948), older age (65–69 years: HR?=?2.165, 95% CI 1.214–3.861; 70–74 years: HR?=?2.324, 95% CI 1.294–4.174; ≥75 years: HR?=?2.448, 95% CI 1.309–4.578), family history of CHD (HR?=?1.993, 95% CI 1.249–3.179), diabetes (HR?=?2.287, 95% CI 1.700–3.078), current smoking (HR?=?2.289, 95% CI 1.512–3.466) and alcohol drinking socially (HR?=?0.589, 95% CI 0.379–0.913). Diabetes was a risk factor for both stroke and CHD, while age, family history of CHD, and sodium intake score were risk factors for stroke alone. Sex, dyslipidemia, smoking and exercise habits were risk factors for CHD alone. The risk of CHD in dyslipidemic patients on statin treatment was comparable to the risk in patients without dyslipidemia (HR?=?1.134, 95% CI 0.604–2.126). However, in dyslipidemic patients not on statin treatment, the HR increased to 1.807 (95% CI 1.156–2.825). In conclusion, some risk factors for CVD in hypertensive patients being treated with antihypertensive drugs with no history of CVD differed between CHD and stroke. These results suggest the importance of managing dyslipidemia with a statin for primary prevention of CHD, as well as the importance of hypertension therapy.     

Interplay of Coronary Artery Calcium and Risk Factors for Predicting CVD/CHD Mortality: The CAC Consortium

ObjectivesThis study sought to evaluate the association and burden of coronary artery calcium (CAC) with long-term, cause-specific mortality across the spectrum of baseline risk.BackgroundAlthough CAC is a known predictor of short-term, all-cause mortality, data on long-term and cause-specific mortality are inadequate.MethodsThe CAC Consortium cohort is a multicenter cohort of 66,636 participants without coronary heart disease (CHD) who underwent CAC testing. The following risk factors (RFs) were considered: 1) current cigarette smoking; 2) dyslipidemia; 3) diabetes mellitus; 4) hypertension; and 5) family history of CHD.ResultsDuring the 12.5-years median follow-up, 3,158 (4.7%) deaths occurred; 32% were cardiovascular disease (CVD) deaths. Participants with CAC scores ≥400 had a significantly increased risk for CHD and CVD mortality (hazard ratio [HR]: 5.44; 95% confidence interval [CI]: 3.88 to 7.62; and HR: 4.15; 95% CI: 3.29 to 5.22, respectively) compared with CAC of 0. Participants with ≥3 RFs had a smaller increased risk for CHD and CVD mortality (HR: 2.09; 95% CI: 1.52 to 2.85; and HR: 1.84; 95% CI: 1.46 to 2.31, respectively) compared with those without RFs. Across RF strata, CAC added prognostic information. For example, participants without RFs but with CAC ≥400 had significantly higher all-cause, non-CVD, CVD, and CHD mortality rates compared with participants with ≥3 RFs and CAC of 0.ConclusionsAcross the spectrum of RF burden, a higher CAC score was strongly associated with long-term, all-cause mortality and a greater proportion of deaths due to CVD and CHD. Absence of CAC identified people with a low risk over 12 years of follow-up, with most deaths being non-CVD in nature, regardless of RF burden.     

Adherence to dietary guidelines and cardiovascular disease risk in the EPIC-NL cohort

Background

Global and national dietary guidelines have been created to lower chronic disease risk. The aim of this study was to assess whether greater adherence to the WHO guidelines (Healthy Diet Indicator (HDI)); the Dutch guidelines for a healthy diet (Dutch Healthy Diet-index (DHD-index)); and the Dietary Approaches to Stop Hypertension (DASH) diet was associated with a lower risk of cardiovascular disease (CVD), coronary heart disease (CHD) or stroke.

Methods

A prospective cohort study was conducted among 33,671 healthy Dutch men and women aged 20–70 years recruited into the EPIC-NL study during 1993–1997. We used Cox regression adjusted for relevant confounders to estimate the hazard ratios per standard deviation increase in score and 95% confidence intervals (CI) of the associations between the dietary guidelines and CVD, CHD and stroke risk.

Results

After an average follow-up of 12.2 years, 2752 CVD cases were documented, including 1630 CHD cases and 527 stroke cases. We found no association between the HDI (0.98, 95% CI 0.94; 1.02) or DHD-index (0.96, 95% CI 0.92; 1.00) and CVD incidence. Similar results were found for these guidelines and CHD or stroke incidence. Higher adherence to the DASH diet was significantly associated with a lower CVD (0.92, 95% CI 0.89; 0.96), CHD (0.91, 95% CI 0.86; 0.95), and stroke (0.90, 95% CI 0.82; 0.99) risk.

Conclusion

The HDI and the DHD-index were not associated with CVD risk, while the DASH diet was significantly associated with a lower risk of developing CVD, CHD and stroke.     

Systolic blood pressure, diabetes and the risk of cardiovascular diseases in the Asia-Pacific region

OBJECTIVE: To assess the association between systolic blood pressure (SBP) and cardiovascular diseases (CVD) among participants with and without diabetes from cohorts in the Asia-Pacific region. RESEARCH DESIGN AND METHODS: Hazards ratios and 95% confidence intervals (CI) for CVD were calculated from Cox models, stratified by sex and region and adjusted for age using individual participant data from 36 cohort studies. Repeat measurements of SBP were used to adjust for regression dilution bias. RESULTS: During follow-up, 7387 fatal or non-fatal cardiovascular endpoints were recorded among 368 307 participants (6.4% with diabetes). SBP was associated with coronary heart disease (CHD), ischaemic stroke and haemorrhagic stroke in a continuous log-linear fashion among individuals with diabetes, as well as those without diabetes. Overall, each 10 mmHg higher usual SBP was associated with 18% (95% CI: 9-27%) and 23% (19-26%) greater risk for CHD among those with and without diabetes, respectively. The corresponding values for ischaemic stroke were 29% (14-45%) and 43% (37-50%), and for haemorrhagic stroke, 56% (32-83%) and 74% (66-82%). The test for heterogeneity by diabetes status in each of these associations was not significant (P >or= 0.10). CONCLUSIONS: Systolic blood pressure is an important marker of risk of CVD in people with and without diabetes. A given reduction in systolic blood pressure is likely to have a similar relative effect on reducing the risk of a cardiovascular event, regardless of diabetes status.     

Menstrual cycle irregularity and risk for future cardiovascular disease

Cross-sectional studies suggest that women who have irregular menstrual cycles and hyperandrogenism may be at increased risk for cardiovascular disease (CVD). However, prospective data are lacking on the relationship between menstrual cycle irregularity and subsequent CVD risk. The objective of this study was to assess prospectively the risk for coronary heart disease (CHD) and stroke associated with a history of irregular menstrual cycles. The study design was a prospective cohort study of 82,439 female nurses who provided information in 1982 on prior menstrual regularity (at ages 20-35 yr) and were followed through 1996 for cardiovascular events. Incident reports of nonfatal myocardial infarction, fatal CHD, and nonfatal and fatal stroke were made. Medical records were reviewed for confirmation. During 14 yr (1,155,915 person-yr) of follow-up, there were 1417 incident cases of CHD and 838 incident cases of stroke, including 471 cases of ischemic stroke. Compared with women reporting a history of very regular menstrual cycles, women reporting usually irregular or very irregular cycles had an increased risk for nonfatal or fatal CHD [age-adjusted relative risks (RR), 1.25 and 1.67, respectively; 95% confidence intervals (CI), 1.07-1.47 and 1.35-2.06, respectively]. Increased risks for CHD associated with prior cycle irregularity remained significant after adjustment for body mass index and several potential confounders. There was a nonsignificant increase in overall stroke risk (RR, 1.30; 95% CI = 0.97-1.74) and in ischemic stroke risk (RR, 1.40; 95% CI = 0.97-2.04) associated with very irregular cycles. Menstrual cycle irregularity may be a marker of metabolic abnormalities predisposing to increased risk for CVD.     

Traditional Framingham risk factors fail to fully account for accelerated atherosclerosis in systemic lupus erythematosus

OBJECTIVE: The frequency of coronary heart disease (CHD) and stroke are increased in systemic lupus erythematosus (SLE), but the extent of the increase is uncertain. We sought to determine to what extent the increase could not be explained by common risk factors. METHODS: The participants at two SLE registries were assessed retrospectively for the baseline level of the Framingham study risk factors and for the presence of vascular outcomes: nonfatal myocardial infarction (MI), death due to CHD, overall CHD (nonfatal MI, death due to CHD, angina pectoris, and congestive heart failure due to CHD), and stroke. For each patient, the probability of the given outcome was estimated based on the individual's risk profile and the Framingham multiple logistic regression model, corrected for observed followup. Ninety-five percent confidence intervals (95% CIs) were estimated by bootstrap techniques. RESULTS: Of 296 SLE patients, 33 with a vascular event prior to baseline were excluded. Of the 263 remaining patients, 34 had CHD events (17 nonfatal MIs, 12 CHD deaths) and 16 had strokes over a mean followup period of 8.6 years. After controlling for common risk factors at baseline, the increase in relative risk for these outcomes was 10.1 for nonfatal MI (95% CI 5.8-15.6), 17.0 for death due to CHD (95% CI 8.1-29.7), 7.5 for overall CHD (95% CI 5.1-10.4), and 7.9 for stroke (95% CI 4.0-13.6). CONCLUSION: There is a substantial and statistically significant increase in CHD and stroke in SLE that cannot be fully explained by traditional Framingham risk factors alone.     

Obstructive sleep apnea and risk of cardiovascular disease and all-cause mortality: A meta-analysis of prospective cohort studies

Background

The association between obstructive sleep apnea (OSA) and the incidence of cardiovascular disease (CVD) has been examined in many studies. However, the findings are not entirely consistent across studies. Our goal was to evaluate the association between OSA and risk of CVD and all-cause mortality by performing a meta-analysis of prospective cohort studies.

Methods

We used generalized least squares regression models to estimate the dose–response relationship. Heterogeneity, subgroup, and sensitivity analyses and publication bias were performed.

Results

Twelve prospective cohort studies involving 25,760 participants were included in the meta-analysis. The overall combined relative risks for individuals with severe OSA compared with individuals with an AHI of < 5 were 1.79 (95% confidence interval [CI]: 1.47 to 2.18) for CVD, 1.21 (95% CI: 0.75 to 1.96) for incident fatal and non-fatal coronary heart disease, 2.15 (95% CI: 1.42 to 3.24) for incident fatal and non-fatal stroke, and 1.92 (95% CI: 1.38 to 2.69) for deaths from all-causes. A positive association with CVD was observed for moderate OSA but not for mild OSA. The results of the dose–response relationship indicated that per 10-unit increase in the apnea–hypopnea index was associated with a 17% greater risk of CVD in the general population.

Conclusions

This meta-analysis of prospective cohort studies suggests that severe OSA significantly increases CVD risk, stroke, and all-cause mortality. A positive association with CVD was observed for moderate OSA but not for mild OSA.     

Association between birth weight and risk of cardiovascular disease: Evidence from UK Biobank

Background and aimsBirth weight has been linked to cardiovascular disease (CVD) risk in adulthood, but no consensus has emerged on the threshold of birth weight for the lowest CVD risk and few studies have examined potential interaction between birth weight and adult adiposity.Methods and resultsA total of 256,787 participants, who had birth weight data and were free of CVD at baseline, were included from UK Biobank. Multivariate restricted cubic splines and Cox regression models were used to assess the association between birth weight and CVD. We observed nonlinear inverse associations of birth weight with the risk of coronary heart disease (CHD), stroke, and heart failure. Participants with the first quintile of birth weight (≤2.85 kg) had higher risks for CHD (hazard ratio [HR] = 1.23, 95% confidence interval [CI]: 1.15–1.32), stroke (HR = 1.19, 95% CI: 1.03–1.37), and heart failure (HR = 1.28, 95% CI: 1.11–1.48), as compared to the fourth quintile (3.41–3.79 kg). There was a significant interaction between birth weight and adult body mass index (BMI) on CHD and heart failure (both P for interaction <0.001), showing the highest risk for those who had birth weight ≤2.85 kg and BMI ≥30 kg/m² (HR = 1.96, 95% CI: 1.70–2.25 and HR = 2.39, 95% CI: 1.77–3.22, respectively).ConclusionsOur findings indicate nonlinear inverse associations between birth weight and CVD risk, with a threshold of 3.41–3.79 kg for the lowest risk. Moreover, low birth weight may interact with adult obesity to increase the risk of CHD and heart failure.