全球可改变风险因素对心血管疾病和死亡的影响。
Global Effect of Modifiable Risk Factors on Cardiovascular Disease and Mortality.
机构信息
The authors' affiliations are as follows: the Center for Population Health Innovation, University Heart and Vascular Center Hamburg (C.M., F.M.O., T.L., R.T., J.W., A.Z., S.B.), University Medical Center Hamburg-Eppendorf (C.M., F.M.O., T.L., R.T., J.W., A.Z., S.B.), the German Center for Cardiovascular Research (DZHK) Partner Site Hamburg-Kiel-Lübeck (C.M., T.L., R.T., J.W., S.B.), the Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, and Network Aging Research, Heidelberg University, Heidelberg (H.B., B.S.), the Department of Internal Medicine B, University Medicine Greifswald, and DZHK Partner Site Greifswald, Greifswald (M.D.), DZHK Partner Site Munich Heart Alliance (W.K., A. Peters), the German Heart Center, Technical University of Munich (W.K.), and the Institute for Medical Information Processing, Biometry, and Epidemiology, Medical Faculty, Ludwig Maximilians Universität München (A. Peters, B.T.), Munich, the Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm (W.K.), the Institute of Clinical Chemistry and Laboratory Medicine (K.J.L.), Preventive Cardiology and Preventive Medicine (P.S.W.), and Clinical Epidemiology and Systems Medicine, Center for Thrombosis and Hemostasis (P.S.W.), University Medical Center of the Johannes Gutenberg-University Mainz, DZHK Partner Site Rhine-Main (K.J.L., P.S.W.), and Institute for Molecular Biology (P.S.W.), Mainz, the University Heart and Vascular Center Frankfurt, DZHK Partner Site Rhine-Main, Frankfurt (D.M.L.), the Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (A. Peters, B.T.), and German Center for Diabetes Research (DZD) Partner Site Munich-Neuherberg (A. Peters, B.T.), Neuherberg - all in Germany; the Department of Medicine (Cardiology), McMaster University, Hamilton, Canada (D.P.L.); the Experimental Medicine Research Unit, School of Medicine, National Autonomous University of Mexico, Mexico City (J.A.-D.), and Centro de Estudios en Diabetes, Centro de Investigacion en Salud Poblacional, Instituto Nacional de Salud Publica, Cuernavaca (C.G.) - both in Mexico; Université de Lille, INSERM, Centre Hospitalier University de Lille, Institut Pasteur de Lille, UMR1167-RID-AGE-Risk Factors and Molecular Determinants of Aging-Related Diseases, Epidemiology and Public Health Department, Lille (P.A.), the Department of Cardiology, INSERM UMR1295, Toulouse Rangueil University Hospital, Toulouse (J.F.), and the Department of Public Health, Strasbourg University Hospital, University of Strasbourg, Strasbourg (M.M.) - all in France; the Division of Clinical and Health Services Research, National Institute on Minority Health and Health Disparities (L.A.-S.), and the Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute (M.N.), National Institutes of Health, Bethesda, MD; the Department of Public Health and Primary Care, Ghent University, Ghent, Belgium (D.D.B.); the Department of Medicine, Baylor College of Medicine (C.M.B.), and Michael E. DeBakey Veterans Affairs Hospital and Baylor College of Medicine (V.N.), Houston, and the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (J.L.) - all in Texas; the CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru (A.B.-O., J.J.M.); the Department of Epidemiology and Public Health (M.B.) and the Research Department of Primary Care and Population Health (S.G.W.), University College London, London, the Centre for Public Health, Queens University Belfast, Belfast (F.K.), and the Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, Dundee (H.T.-P.) - all in the United Kingdom; the Emory Global Diabetes Research Center and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta (R.M.C.-L.); the School of Public Health, University of Queensland, Brisbane (A.D.), the Division of Cancer Epidemiology, Cancer Council Victoria (A.M.H.), the Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, the University of Melbourne (A.M.H.), and Baker Heart and Diabetes Institute (J.E.S.), Melbourne, the Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney (J.J.M.), and the George Institute for Global Health (A.E.S.), Sydney, and the School of Population Health (A.E.S.), University of New South Wales, Kensington (L.A.S.) - all in Australia; the Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome (C.D., L.P.), the Research Center in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese (M.M.F., L.I., G.V.), the Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli (G. de Gaetano, L.I.), Clinica Medica, University of Milano-Bicocca, Milan (G. Grassi), and the MONICA (Monitoring Cardiovascular Diseases)-Friuli Study Group, Udine (D.V.) - all in Italy; the Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, National Institute of Cardiology, and Lazarski University, Warsaw (W.D.), and the Department of Epidemiology and Population Studies, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow (A. Pajak) - all in Poland; the Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen (R.P.D.), and the Departments of Neurology (M.K.I.) and Epidemiology (M.K.I., M.K.), Erasmus University Medical Center Rotterdam, Rotterdam - both in the Netherlands; the Department of Clinical Sciences Malmö, Lund University, Malmö (G.E., O.M.), the Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University (U.R.), and the Department of Medical Sciences, Uppsala University, Uppsala (L.L.), and the Department of Public Health and Clinical Medicine, University of Umea, Umea (S. Söderberg) - all in Sweden; the Department of Epidemiology, Tel Aviv University School of Public Health, Tel Aviv, Israel (U.G.); HUNT (Trøndelag Health Study) Research Center, Department of Public Health and Nursing, Norwegian University of Science and Technology, Levanger (K.H.), the K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Trondheim(K.H.), the Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog (M.N.L.), the K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo (M.N.L.), and the Department of Clinical Medicine, University of Tromsø the Arctic University of Norway, Tromsø (E.B.M.) - all in Norway; the Department of Chronic Diseases, Institute for Clinical Effectiveness and Health Policy, Buenos Aires (V.I.); Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia (M.J., A.M.P.); the Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki (P.J., K.K., V.S.); Medical Research Council-Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda (P.K., J.M.); the Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences (D.K.), the Liver and Pancreaticobiliary Disease Research Center (R.M.), the Digestive Oncology Research Center (R.M., H.P.), and the Digestive Disease Research Center (R.M., M.N., H.P., S.G.S.), Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences - all in Tehran, Iran; the National Research Center for Therapy and Preventive Medicine, Ministry of Healthcare of the Russian Federation, Moscow (A.K.), and the Research Institute of Internal and Preventive Medicine-Branch of the Federal Research Center Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, Novosibirsk (S.M.) - both in Russia; the Department of Clinical Medicine, Faculty of Health and Medical Sciences (A.L.), and the Department of Cardiology, Bispebjerg Hospital (E.P.), University of Copenhagen, and the Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital (A.L.) - both in Copenhagen; the Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia (A.M.); the Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka (T.N., S. Sakata), and the Global Center of Excellence Program Study Group, Yamagata University School of Medicine, Yamagata (M.W.) - both in Japan; the School of Medicine, University of Passo Fundo, Passo Fundo (K.O.), and the Department of Public Health, Postgraduate Program in Public Health, Federal University of Santa Catarina, Florianopolis (E.O.) - both in Brazil; the School of Health Sciences and Education, Harokopio University, Athens, Greece (D.P.); the National Council of Applied Economic Research, Delhi (A. Perianayagam), and the International Institute for Population Sciences, Mumbai (A. Perianayagam) - both in India; the Catalan Department of Health, Barcelona (S. Sans); the Hypertension in Africa Research Team, South African Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom (A.E.S.), and the School of Mathematics, Statistics, and Computer Science, University of KwaZulu-Natal, Pietermaritzburg (A.Z.) - both in South Africa; the Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal (S.K.S.); the Laboratory of Population Studies, Institute of Cardiology, and the Department of Preventive Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania (A.T.); the China Center for Health Development Studies (Y.Y.) and Center for Healthy Aging and Development Studies, National School of Development (Y.Z.), Peking University, and the Key Laboratory of Epidemiology of Major Diseases, Peking University, Ministry of Education (Y.Y.) - both in Beijing; the Center for the Study of Aging and Human Development and Geriatrics Division, Medical School of Duke University, Durham, NC (Y.Z.); and Cardio-CARE, Davos (A.Z., S.B.), and the Swiss Institute of Bioinformatics, Lausanne (A.Z.) - both in Switzerland.
出版信息
N Engl J Med. 2023 Oct 5;389(14):1273-1285. doi: 10.1056/NEJMoa2206916. Epub 2023 Aug 26.
BACKGROUND
Five modifiable risk factors are associated with cardiovascular disease and death from any cause. Studies using individual-level data to evaluate the regional and sex-specific prevalence of the risk factors and their effect on these outcomes are lacking.
METHODS
We pooled and harmonized individual-level data from 112 cohort studies conducted in 34 countries and 8 geographic regions participating in the Global Cardiovascular Risk Consortium. We examined associations between the risk factors (body-mass index, systolic blood pressure, non-high-density lipoprotein cholesterol, current smoking, and diabetes) and incident cardiovascular disease and death from any cause using Cox regression analyses, stratified according to geographic region, age, and sex. Population-attributable fractions were estimated for the 10-year incidence of cardiovascular disease and 10-year all-cause mortality.
RESULTS
Among 1,518,028 participants (54.1% of whom were women) with a median age of 54.4 years, regional variations in the prevalence of the five modifiable risk factors were noted. Incident cardiovascular disease occurred in 80,596 participants during a median follow-up of 7.3 years (maximum, 47.3), and 177,369 participants died during a median follow-up of 8.7 years (maximum, 47.6). For all five risk factors combined, the aggregate global population-attributable fraction of the 10-year incidence of cardiovascular disease was 57.2% (95% confidence interval [CI], 52.4 to 62.1) among women and 52.6% (95% CI, 49.0 to 56.1) among men, and the corresponding values for 10-year all-cause mortality were 22.2% (95% CI, 16.8 to 27.5) and 19.1% (95% CI, 14.6 to 23.6).
CONCLUSIONS
Harmonized individual-level data from a global cohort showed that 57.2% and 52.6% of cases of incident cardiovascular disease among women and men, respectively, and 22.2% and 19.1% of deaths from any cause among women and men, respectively, may be attributable to five modifiable risk factors. (Funded by the German Center for Cardiovascular Research (DZHK); ClinicalTrials.gov number, NCT05466825.).
背景
有五个可改变的风险因素与心血管疾病和任何原因导致的死亡有关。使用个体水平数据评估这些风险因素在区域和性别特异性方面的流行程度及其对这些结果的影响的研究尚缺乏。
方法
我们对来自全球心血管风险联合会中 34 个国家和 8 个地理区域的 112 项队列研究的个体水平数据进行了汇总和协调。我们使用 Cox 回归分析，根据地理区域、年龄和性别，对风险因素（体重指数、收缩压、非高密度脂蛋白胆固醇、当前吸烟和糖尿病）与心血管疾病事件和任何原因导致的死亡之间的关联进行了检验。我们还估计了 10 年心血管疾病发病率和 10 年全因死亡率的人群归因分数。
结果
在 1518028 名参与者中（54.1%为女性），中位年龄为 54.4 岁，我们注意到五个可改变风险因素的流行程度存在区域差异。在中位随访 7.3 年（最长随访 47.3 年）期间，有 80596 名参与者发生心血管疾病事件，在中位随访 8.7 年（最长随访 47.6 年）期间，有 177369 名参与者死亡。对于所有五个风险因素的综合情况，女性的 10 年心血管疾病发病率的全球人群归因分数为 57.2%（95%置信区间[CI]，52.4 至 62.1），男性为 52.6%（95%CI，49.0 至 56.1），相应的 10 年全因死亡率为 22.2%（95%CI，16.8 至 27.5）和 19.1%（95%CI，14.6 至 23.6）。
结论
来自全球队列的个体水平数据的协调分析显示，女性心血管疾病事件的 57.2%和男性的 52.6%、女性任何原因导致的死亡的 22.2%和男性的 19.1%可能归因于五个可改变的风险因素。（由德国心血管研究中心（DZHK）资助；ClinicalTrials.gov 编号，NCT05466825。）
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