高血压患者心血管疾病风险及其性别差异分析

Cardiovascular Disease Risk and its Gender Differences in Hypertension Patients

目的:分析浙江省奉化区高血压患者心血管疾病危险因素情况,评估未来10年动脉粥样硬化性心血管病(ASCVD)发病风险,并分析其性别差异,为社区早期发现与管理ASCVD高危患者提供依据。方法:对奉化区5个街道参与年度健康体检的35~84岁高血压患者,利用临床决策支持系统自动评估10年ASCVD发病风险。分析各心血管疾病相关危险因素及其性别差异,使用线性回归计算各因素随年龄的变化情况,并使用协方差分析比较变化的性别差异。结果:在9050名参与者中,糖尿病、血脂异常、吸烟、肥胖和高同型半胱氨酸血症的患病率分别为20.8%、37.7%、13.9%、41.5%和21.3%。合并不少于三种危险因素的比例为12.5%。10年ASCVD发病风险高危比例为24.9%。男性与女性在危险因素患病率、数量、危险分层等方面,均差异又统计学意义。男性与女性危险因素随年龄的变化也存在显著差异。年龄段相对较低时,女性心血管疾病风险低于男性,差异随年龄增大而减小甚至逆转。结论:奉化区高血压患者心血管疾病危险因素患病率和10年ASCVD发病风险高危比例较高并存在明显的性别差异,应采取针对性措施及早和规范干预。

Objective: To analyze the risk factors of cardiovascular disease(CVD) in patients with hypertension in Fenghua, Zhejiang, to evaluate the 10-year atherosclerotic cardiovascular disease(ASCVD)risk, and to analyze their gender differences. The ultimate goal is to provide theoretical foundation for early detection and management of hypertension patients having high ASCVD risk in the community. Methods:For 35-84 year old hypertension patients who participated in the annual health examination in 5 streets in Fenghua, the 10-year ASCVD risk was evaluated automatically using the clinical decision support system.Cardiovascular risk factors and there gender differences were analyzed. Linear regression was applied to analyze their change patterns. Analysis of covariance was applied to analyze the gender differences. Results:Of the 9050 participants, the prevalence of diabetes, dyslipidemia, smoking, obesity and hyperhomocysteinemia were 20.8%, 37.7%, 13.9%, 41.5% and 21.3% respectively. 12.5% of the patients had at least three risk factors. The proportion of participants with high ASCVD risk was 24.9%. There were significant differences between male and female in the prevalence and the number of risk factors and therefore the risk levels. Gender differences were also observed in the trajectories of risk factors. When the age was relatively low, the CVD risk in women was lower than that in men, and the difference decreased or even reversed with the increase of age. Conclusions: The observed prevalence of CVD risk factors and 10-year ASCVD risk in patients with hypertension in Fenghua district were high, and there existed great gender differences. Targeted and preventive measures should be taken to better care hypertension patients with high ASCVD risk.