心血管代谢危险因素与心血管疾病发病和死亡的关联及归因负担  

Association of cardiometabolic risk factors with mortality and morbidity of cardiovascular disease and attributable burden

作　　者：王明宏 张飞云 黄宜林 韩国亮 马海滨[5] 游凯[6] 李卫[2] 代表前瞻性城乡流行病学研究中国地区协作者 WANG Minghong;ZHANG Feiyun;HUANG Yiling;HAN Guoliang;MA Haibin;YOU Kai;LI Wei;on behalf of the Prospective Urban and Rural Epidemiology(PURE)Study in China(School of Population Medicine and Public Health,Chinese Academy of Medical Sciences&Peking UnionMedical college,Beijing 100005,China;Chinese Academy of Medical Sciences,Peking Union Medical college,National Center of Cardiovascular Disease,Fu Wai cardiovascular Hospital,State Key Laboratory of Cardiovascular Disease;Unit 32261 of the People's Liberation Army;Inner Mongolia Autonomous Region,Bayannaoer City Centre for Disease Control and Prevention;Xining Center for Disease Control and Prevention;Shun yi District Center for Disease Control and Prevention;不详)

机构地区：[1]中国医学科学院/北京协和医学院,群医学及公共卫生学院,北京100005 [2]中国医学科学院北京协和医学院,国家心血管病中心,国家心血管疾病临床医学研究中心,阜外医院,医学统计部 [3]中国人民解放军32261部队 [4]内蒙古自治区巴彦淖尔市疾病预防控制中心 [5]青海省西宁市疾病预防控制中心 [6]北京市顺义区疾病预防控制中心 [7]不详

出　　处：《中华高血压杂志(中英文)》2025年第3期252-257,共6页Chinese Journal of Hypertension

基　　金：PURE中国区研究,加拿大McMaster大学人群健康研究所,新探健康发展研究中心,国家心血管病中心/国家心血管疾病临床医学研究中心项目(NCRC2020002);阜外医院项目(2023-GSP-GG-36);中央高水平医院临床研专项(2022-PUMCH-C-026)。

摘　　要：目的探讨我国心血管代谢危险因素与心血管疾病发病和死亡之间的关联强度及归因负担。方法本研究依托前瞻性城乡流行病学研究中国地区(PURE-China)队列,于2005—2009年在我国12个省份115个城乡社区招募年龄35~70岁的参与者作为研究对象,每3年随访一次,本次分析随访时间截止至2021年4月。通过多因素Cox脆弱模型分析心血管代谢危险因素(高血压、糖尿病、血脂异常、腹型肥胖)与心血管疾病发病与死亡之间的关联,并通过计算人群归因风险分值探究心血管疾病的归因负担。结果纳入39693名研究对象,平均年龄(50.41±9.62岁),中位随访时间为11.9年,记录2086例(5.3%)全因死亡、688例(1.7%)心血管疾病死亡和3112例(7.8%)心血管事件。多因素Cox共享脆弱模型结果显示,糖尿病和高血压是增加心血管疾病风险最高的两种代谢危险因素,其中糖尿病与全因死亡风险相关(HR=1.665,95%CI 1.459~1.899,P<0.001),高血压则与心血管疾病死亡风险相关(HR=2.388,95%CI 2.002~2.849,P<0.001),并且增加心血管事件的发生风险(HR=1.983,95%CI 1.833~2.146,P<0.001)。此外,研究对象中18.2%全因死亡、49.7%心血管疾病死亡、42.0%心血管事件的发生风险归因于代谢危险因素,所有代谢危险因素中高血压贡献最大,分别解释了13.3%、36.1%、28.6%的全因死亡、心血管疾病死亡、心血管事件发生。结论心血管代谢危险因素与心血管事件发生和死亡风险增加存在关联,提示早期对高血压、糖尿病、血脂异常、腹型肥胖实施综合干预,对降低心血管疾病负担至关重要。Objective To investigate the associations of cardiometabolic risk factors with cardiovascular disease morbidity and mortality and to quantify the population attributable fraction.Methods This study was based on Prospective Urban Rural Epidemiology-China(PURE-China),a large cohort study involving subjects aged 35-70 years from 115 urban and rural communities in 12 provinces of China.The subjects were recruited from 2005 to 2009 and followed up once every three years.The follow-up time of this analysis ended in April 2021.The associations of cardiometabolic risk factors(hypertension,diabetes,dyslipidemia,and abdominal obesity)with cardiovascular disease morbidity and mortality were evaluated using multifactorial Cox fragility model,and the attributable burden of cardiovascular disease was explored by calculating the population-attributable risk score.Results The mean age of the cohort(39693 participants)was(50.41±9.62)years.After a median follow-up of 11.9 years,2086(5.3%)all-cause deaths and 688(1.7%)cardiovascular deaths as well as 3112(7.8%)cardiovascular events were recorded.Multifactorial Cox fragility modeling revealed that diabetes and hypertension were the two most important metabolic risk factors,the hazard ratio(HR)of diabetes was 1.665[95%confidential interval(CI):1.459-1.899,P<0.001]for all-cause mortality,and the HRs of hypertension were 2.388(95%CI:2.002-2.849,P<0.001)for cardiovascular disease mortality and 1.983(95%CI:1.833-2.146,P<0.001)for cardiovascular disease morbidity.In addition,18.2%of all-cause and 49.7%of cardiovascular mortality,and 42.0%of cardiovascular events were attributed to the effect of cardiometabolic risk factors.Among all metabolic risk factors,hypertension contributed the most,explaining 13.3%,36.1%and 28.6%of all-cause deaths,cardiovascular diseases and cardiovascular events respectively.Conclusion Cardiometabolic risk factors are associated with increased risk of cardiovascular events and death,highlighting the importance of comprehensive management for hypertension,diabete

关 键 词：心血管代谢危险因素 高血压 心血管疾病 人口归因分值 

分 类 号：R54[医药卫生—心血管疾病]