在52个国家与心肌梗塞相关的潜在可修改风险因素的影响 (INTERHEART研究):病例控制研究研究
Salim Yusuf1, Steven Hawken, Stephanie Ounpuu
1Population Health Research Institute, Hamilton General Hospital, 237 Barton Street East, Hamilton, Ontario, Canada L8L 2X2. yusufs@mcmaster.ca
Lancet (London, England)
|September 15, 2004
概括
吸烟,高脂,高血压和糖尿病等心血管疾病风险因素在全球显著增加心脏病发作风险. 解决这些常见因素提供了一种普遍的方法来预防全世界大多数心脏病发作.
科学领域:
- 心脏病学 心脏病学
- 流行病学 流行病学
- 公共卫生 公共卫生
背景情况:
- 心血管疾病 (CVD) 负担在低收入和中等收入国家最高,但风险因素数据主要来自发达国家.
- 在全球许多地区,已确定的风险因素对冠心病 (CHD) 的影响仍然在很大程度上未被描述.
研究的目的:
- 调查各种风险因素与急性心肌梗塞 (AMI) 在多样化的国际人口中的关联.
- 确定全球不同地区针对AMI的已识别风险因素的人口归因风险 (PAR).
主要方法:
- 一项标准化,跨国病例控制研究,涉及52个国家的15152例病例和14820例控制.
- 风险因素的评估包括吸烟,高血压,糖尿病,腰比,饮食,体力活动,酒精消费,阿波利波蛋白 (Apo) 和心理社会因素.
- 对AMI进行概率比率 (OR) 和99%置信区间 (CI) 的计算,以及与人口相关的风险 (PAR).
主要成果:
- 吸烟 (OR 2.87),升高的ApoB/ApoA1比率 (OR 3.25),高血压 (OR 1.91),糖尿病 (OR 2.37) 和腹部肥胖 (OR 1.12-1.62) 与AMI存在显著的关联.
- 心理社会因素 (OR 2.67) 和水果/蔬菜摄入量不足 (OR 0.70由于缺乏消费) 也显示出与AMI有显著联系.
- 在所有地区,这些9个风险因素共同解释了90-94%的人口可归因的AMI风险,分别是男性和女性.
结论:
- 关键可修改的风险因素包括异常脂质,吸烟,高血压,糖尿病,腹部肥胖,心理社会因素,饮食,酒精和体力活动是全球心肌梗塞的主要原因.
- 这些发现支持制定统一的,全世界的心肌梗塞预防策略,有潜力避免大多数早发病例.
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