缺血性心血管病:一个反映血脂异常潜在危险的新指标

Ischemic cardiovascular diseases: a new index to reflect the potential risk from dyslipidemia

目的 提出一个能够反映我国人群心血管病发病特点的、用于评价血脂异常潜在威胁的新指标。方法 资料包括中国心血管病流行病学多中心协作研究 1991～ 2 0 0 0年心血管病发病监测资料和该项目在“六五”和“八五”期间建立的 2个队列随访资料以及中美心肺疾病流行病学合作研究队列随访资料。分析冠心病事件和缺血性脑卒中事件绝对危险和相对危险随基线血清胆固醇水平升高的变化 ,用Cox比例风险模型调整可能的混杂因素。提出将冠心病事件和缺血性脑卒中事件合计 ,统称为缺血性心血管病事件。结果 (1)监测资料和队列随访资料均证实我国人群缺血性脑卒中的发病率约为冠心病事件的 2倍 ,二者的联合终点事件约占所有心血管病事件发病的 6 5 %。 (2 )在3个现有的大样本长期观察的队列人群中 ,血清总胆固醇与冠心病事件和缺血性脑卒中事件年龄标化发病均呈显著正相关。 (3)除“八五”队列男性外 ,所有队列在相同血清总胆固醇水平均显示缺血性脑卒中事件年龄标化发病率高于冠心病事件发病率。如 ,当TC≥ 6 2 4mmol L (1mmol L =38 6 7mg dl)时 ,冠心病事件发病的年龄标化发病率仅约为 (110～ 130 ) 10万 ,而缺血性心血管病事件的年龄标化发病率为 (36 0～ 5 5 0 ) 10万。

Objective To propose an appropriate index for evaluation of the potential risk caused by hyperdislipidemia, which is suitable to the characteristics of cardiovascular diseases profile in China. Methods Data for analysis included surveillance data from the China Multi-center Collaborative Study of Cardiovascular Epidemiology (MUCA) and cohort follow-up data from 2 cohorts in China MUCA and 1 cohort from the PRC-USA Collaborative Study of Cardiovascular and Cardiopulmonary Epidemiology. Both surveillance and follow-up data were presented to show the characteristics of cardiovascular diseases in Chinese population. The association between baseline serum total cholesterol (TC) and incidence of coronary heart disease (CHD) events and ischemic stroke were analyzed in scrutiny. The combination of CHD and ischemic stroke called ischemic cardiovascular diseases were proposed as a new index for evaluation of potential risk from dyslipedemia. Results (1) Data from both surveillance and follow-up showed that the incidence rate of ischemic stroke was 2 times of that of CHD. The ischemic cardiovascular disease accounted for 65% of the total cardiovascular diseases. (2) Baseline serum TC was significantly positively associated with the age-standardized incidence rate of both CHD events and ischemic stroke in all three large, long-term cohorts. (3) At every level of baseline serum TC, the age-standardized incidence of ischemic stroke events was higher than that of CHD except for males in the 8 th Five-Year Plan cohort. For example, when TC was ≥240 mg/dl, the incidences were only 110-130/100 000 for CHD events but (360-550)/100 000 for ischemic cardiovascular diseases. Conclusion Ischemic cardiovascular disease represents a larger body of cardiovascular diseases profile and is a more appropriate index for evaluation of potential risk from dislipidemia in China.