疾病家族史与冠心病发生风险的关联研究

Family history and risk of coronary heart disease

目的分析疾病家族史对急性冠心病事件（MCE）及缺血性心脏病（IHD）发病风险的影响。方法研究对象来自中国慢性病前瞻陛研究，剔除基线时患有恶性肿瘤、心脏病及脑卒中的个体，纳入485784人进行分析。统计分析采用Cox比例风险模型。结果研究人群随访M=7．2年，随访期间新发MCE3934例，IHD24537例。与无家族史者相比，有家族史者发生MCE及IHD的风险均较高，HR值（95％CI）分别为1．41（1．19～1．65）和1．25（1．18-1．33）。与双亲型家族史相比，同胞型家族史与早发MCE的关联更强（HR=2．97，95％CI：1．80-4．88）；超重／肥胖者中家族史与MCE、IHD的关联更强；吸烟者中家族史与MCE的关联更强。结论有家族史者发生MCE及IHD的风险较高。结果提示应鼓励个体根据疾病家族史信息，及早开展生活方式干预和相关基础疾病的治疗管理。

Objective To evaluate the association of family history with risk of major coronary events （MCE） and ischemic heart disease （IHD）. Methods After excluding participants with heart disease, stroke or cancer at baseline survey, a total of 485 784 participants from the China Kadoorie Biobank, who had no missing data on critical variables, were included in the analysis. Cox regression analysis was used to estimate the hazard ratios （HR） and 95%CI. Subgroup analyses were performed according to the baseline characteristics. Results During a median of 7.2 years of follow-up, we documented 3 934 incident cases of MCE and 24 537 cases of IHD. In multivariable- adjusted models, family history was significantly associated with risk of MCE and IHD. The adjusted HRs （95%C/） were 1.41 （1.19-1.65） and 1.25 （1.18-1.33）, respectively. History of disease among siblings was more strongly associated with early-onset MCE than parental history （HR-----2.97, 95%CI： 1.80-4.88）. Moreover, the association of family history with MCE and IHD was stronger in persons who were overweight or obesive, and the association between family history and MEC was stronger in smokers. Condusion This large-scale, prospective study indicated that family history was an independent risk factor for MCE and IHD in China. The intervention targeting major known lifestyle risk factors and the management of chronic diseases should be strengthened for Chinese population, especially for the individuals with family history were at high risk.