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美国西北大学范伯格医学院Sadiya S Khan团队分析了美国1999-2018年各心脏病亚型的死亡率负担趋势。2020年8月13日，《英国医学杂志》发表了该成果。

为了描述1999-2018年由心脏病亚型引起的死亡率负担趋势，以提供针对性预防策略并减少差异，研究组使用国家死亡证明数据，并按种族、性别、年龄和地理分层，对特定病因的心脏病死亡率进行连续横断面分析。1999-2018年共有1290万人死于心脏病，其中49%为女性，12%为黑人，19%在65岁以下。主要结局指标为每种心脏病亚型的年龄调整死亡率（AAMR）和潜在损失生命年（YPLL），以及各自的平均年百分比变化。

1999-2011年间，因心脏病而导致的死亡人数从752192名下降到596577名，在2018年又增至655381名。1999-2018年，心脏病亚型中归因于缺血性心脏病的总死亡比例从73％降至56％，归因于心力衰竭的比例从8％增加至13％，归因于高血压心脏病的比例从4％增至9％。其中缺血性心脏病所有亚组（种族、性别、年龄和地区）的AAMR始终最高。2011年之后，心力衰竭和高血压性心脏病AAMR的增长速度快于其他亚型。

心力衰竭死亡率增长最快的是黑人，平均年变化率为4.9%；而高血压心脏病死亡率增长最快的是白人，平均年变化率为6.3%。缺血性心脏病造成的潜在生命损失最严重，但黑人白人的差异是由心力衰竭和高血压心脏病造成的。2018年因心脏病死亡导致大约380万潜在生命损失。

总之，自2011年以来，AAMR以及因缺血性心脏病而损失的潜在生命年一直在减少。对于其他几乎所有类型的心脏病，AAMR和潜在损失生命年保持不变或增加。研究组建议对心脏病高危人群进行早期、有针对性地一级和二级预防和控制。

附：英文原文

Title: Heterogeneous trends in burden of heart disease mortality by subtypes in the United States, 1999-2018: observational analysis of vital statistics

Author: Nilay S Shah, Rebecca Molsberry, Jamal S Rana, Stephen Sidney, Simon Capewell, Martin O’Flaherty, Mercedes Carnethon, Donald M Lloyd-Jones, Sadiya S Khan

Issue&Volume: 2020/08/13

Abstract: Objective To describe trends in the burden of mortality due to subtypes of heart disease from 1999 to 2018 to inform targeted prevention strategies and reduce disparities.

Design Serial cross sectional analysis of cause specific heart disease mortality rates using national death certificate data in the overall population as well as stratified by race-sex, age, and geography.

Setting United States, 1999-2018.

Participants 12.9 million decedents from total heart disease (49% women, 12% black, and 19% <65 years old).

Main outcome measures Age adjusted mortality rates (AAMR) and years of potential life lost (YPLL) for each heart disease subtype, and respective mean annual percentage change.

Results Deaths from total heart disease fell from 752192 to 596577 between 1999 and 2011, and then increased to 655381 in 2018. From 1999 to 2018, the proportion of total deaths from heart disease attributed to ischemic heart disease decreased from 73% to 56%, while the proportion attributed to heart failure increased from 8% to 13% and the proportion attributed to hypertensive heart disease increased from 4% to 9%. Among heart disease subtypes, AAMR was consistently highest for ischemic heart disease in all subgroups (race-sex, age, and region). After 2011, AAMR for heart failure and hypertensive heart disease increased at a faster rate than for other subtypes. The fastest increases in heart failure mortality were in black men (mean annual percentage change 4.9%, 95% confidence interval 4.0% to 5.8%), whereas the fastest increases in hypertensive heart disease occurred in white men (6.3%, 4.9% to 9.4%). The burden of years of potential life lost was greatest from ischemic heart disease, but black-white disparities were driven by heart failure and hypertensive heart disease. Deaths from heart disease in 2018 resulted in approximately 3.8 million potential years of life lost.

Conclusions Trends in AAMR and years of potential life lost for ischemic heart disease have decelerated since 2011. For almost all other subtypes of heart disease, AAMR and years of potential life lost became stagnant or increased. Heart failure and hypertensive heart disease account for the greatest increases in premature deaths and the largest black-white disparities and have offset declines in ischemic heart disease. Early and targeted primary and secondary prevention and control of risk factors for heart disease, with a focus on groups at high risk, are needed to avoid these suboptimal trends beginning earlier in life.

DOI: 10.1136/bmj.m2688

Source: https://www.bmj.com/content/370/bmj.m2688

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