美国马萨诸塞州总医院Jennifer E Ho团队研究了心力衰竭危险因素的年龄相关性。2021年3月23日，《英国医学杂志》发表了该成果。
为了探讨普通人群中发生心力衰竭危险因素的年龄差异，研究组进行了一项基于人群的队列研究。共招募了24675名无心力衰竭病史的参与者，按年龄分为年轻人（<55岁；n=11 599）、中年人（55-64岁；n=5587）、老年人（65-74岁；n=5190）和较老老年人（≥75岁；n=2299）。主要观察指标为突发性心力衰竭。
中位随访12.7年后，年轻人、中年人、老年人和较老老年人参与者中分别有138/11599（1%）、293/5587（5%）、538/5190（10%）和412/2299（18%）发生心力衰竭。在年轻参与者中，32%（n=44）的心力衰竭病例被归类为射血分数保留的心力衰竭，而在较老的老年参与者中，这一比例为43%（n=179）。
危险因素包括高血压、糖尿病、当前吸烟史和既往心肌梗死，与年龄较大的参与者相比，年轻参与者的相对危险性更高。例如，年轻人高血压与未来心力衰竭风险增加三倍相关，该风险是较老老年人的1.4倍，差异显著。无论有无危险因素，年轻人患心力衰竭的绝对风险均低于老年人。更重要的是，已知的危险因素解释了年轻参与者中75%的人群归因性心衰风险，而在较老老年人中这一比例为53%，差异显著。同样，年轻人肥胖（21%与13%）、高血压（35%与23%）、糖尿病（14%与7%）和经常吸烟（32%与1%）的人群归因风险亦显著高于较老老年人。
总之，尽管与老年人相比，年轻人的心衰发病率和绝对风险更低，但年轻人中可改变危险因素的关联性更强，且可归因风险更高，这突出了成年人预防工作的重要性。
附：英文原文
Title: Age dependent associations of risk factors with heart failure: pooled population based cohort study
Author: Jasper Tromp, Samantha M A Paniagua, Emily S Lau, Norrina B Allen, Michael J Blaha, Ron T Gansevoort, Hans L Hillege, Douglas E Lee, Daniel Levy, Vasan S Ramachandran, Pim van der Harst, Wiek H van Gilst, Martin G Larson, Sanjiv J Shah, Rudolf A de Boer, Carolyn S P Lam, Jennifer E Ho
Issue&Volume: 2021/03/23
Abstract:
Objective To assess age differences in risk factors for incident heart failure in the general population.
Design Pooled population based cohort study.
Setting Framingham Heart Study, Prevention of Renal and Vascular End-stage Disease Study, and Multi-Ethnic Study of Atherosclerosis.
Participants 24675 participants without a history of heart failure stratified by age into young (<55 years; n=11599), middle aged (55-64 years; n=5587), old (65-74 years; n=5190), and elderly (≥75 years; n=2299) individuals.
Main outcome measure Incident heart failure.
Results Over a median follow-up of 12.7 years, 138/11599 (1%), 293/5587 (5%), 538/5190 (10%), and 412/2299 (18%) of young, middle aged, old, and elderly participants, respectively, developed heart failure. In young participants, 32% (n=44) of heart failure cases were classified as heart failure with preserved ejection fraction compared with 43% (n=179) in elderly participants. Risk factors including hypertension, diabetes, current smoking history, and previous myocardial infarction conferred greater relative risk in younger compared with older participants (P for interaction <0.05 for all). For example, hypertension was associated with a threefold increase in risk of future heart failure in young participants (hazard ratio 3.02, 95% confidence interval 2.10 to 4.34; P<0.001) compared with a 1.4-fold risk in elderly participants (1.43, 1.13 to 1.81; P=0.003). The absolute risk for developing heart failure was lower in younger than in older participants with and without risk factors. Importantly, known risk factors explained a greater proportion of overall population attributable risk for heart failure in young participants (75% v 53% in elderly participants), with better model performance (C index 0.79 v 0.64). Similarly, the population attributable risks of obesity (21% v 13%), hypertension (35% v 23%), diabetes (14% v 7%), and current smoking (32% v 1%) were higher in young compared with elderly participants.
Conclusions Despite a lower incidence and absolute risk of heart failure among younger compared with older people, the stronger association and greater attributable risk of modifiable risk factors among young participants highlight the importance of preventive efforts across the adult life course.
DOI: 10.1136/bmj.n461
Source: https://www.bmj.com/content/372/bmj.n461
BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
官方网址：http://www.bmj.com/
投稿链接：https://mc.manuscriptcentral.com/bmj
本期文章：《英国医学杂志》：Online/在线发表
