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

Risk factors comparison in Chinese patients developing acute coronary syndrome,ischemic or hemorrhagic stroke:a multi-provincial cohort study

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。

Objective To observe the risk factors characteristic of patients developing acute coronary syndrome, ischemic or hemorrhagic stroke in a Chinese population aged 35-64 （n = 30 378）. Method This prospective study was carried out in 11 provinces in China from 1992 to 2003. The association between baseline risk factors and events in the 10-year follow-up period was analyzed. Results （ 1 ） A total of 809 events were recorded during the follow up period and 227 with acute coronary syndrome, 582 with stroke （ ischemic 419, hemorrhagic 146, undefined 17 ） and the 10-year cumulative person-year incidence rates were 114/100 000, 209/100 000 and 73/100 000 for acute coronary syndrome, acute ischemic stroke and acute hemorrhagic stroke, respectively. （2） Rate of having 〉t 1 modifiable risk factors was significantly higher in event group than that in subjects without events （89% vs. 64.7%, P 〈0. 01 ） . （3） Sorted by intensity, the sequence of independently risk factors obtained from multivariate analysis for acute coronary syndrome were hypertension, smoking, hypercholesterolemia and low-HDL-C; for acute iscbemic stroke event were hypertension, diabetes, low-HDL-C, smoking and obesity; for acute hemorrhagic stroke was hypertension. Conclusion The morbidity for cardiovascular diseases is higher in Chinese population with various traditional risk factors than those without or having fewer traditional risk factors and there are various distinct independent risk factors pattern in patients with different cardiovascular diseases subtypes.