老年中国人的心电图异常和心血管风险预测:广州生物银行队列研究
Wen Bo Tian1, Wei Sen Zhang2, Chao Qiang Jiang2
1School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China.
Heart (British Cardiac Society)
|August 27, 2025
概括
多重轻微心电图异常 (EA) 和重大异常会增加老年人心血管疾病 (CVD) 和死亡风险. 然而,心电图异常得分对预测心血管疾病风险的改善有限.
科学领域:
- 心脏病学
- 老年学
- 公共卫生
背景情况:
- 在老年人群中,多种轻微心电图异常 (EA) 与心血管疾病 (CVD) 风险之间存在有限的证据.
- 与单个EA严重程度相比,加权EA评分对心脏病风险的预测价值尚未得到充分确立.
研究的目的:
- 研究心电图异常 (EA) 严重程度和加权EA得分与中国老年人心血管疾病 (CVD) 事件和死亡率的关联.
- 评估EA严重性和心脏病风险得分的增量预测值.
主要方法:
- 从广州生物银行队列研究 (GBCS) 分析了26,846名50岁以上的中国人,没有基线心血管疾病.
- 使用明尼苏达州编码手册对轻微和重大EA进行分类,定义EA的严重程度 (正常,轻微1次,轻微2次,重大).
- 使用考克斯回归与后退阶段选择开发EA评分;使用考克斯回归检查与心血管疾病事件,所有原因和心血管疾病死亡率的关联;使用C指数和净重新分类指数 (NRI) 评估预测性改善.
主要成果:
- 在15. 3年的随访期间,较高的EA严重程度 (一个轻微的,两个+轻微的,严重的) 与发生心血管疾病事件的风险增加有关 (调整后的HR为1. 12-1. 46).
- 对EA评分观察到显著的剂量反应关系,较高的评分表明心血管疾病事件和死亡率的风险大幅增加 (例如,≥60分:HR 3. 16).
- 增加EA得分改善了心血管疾病风险预测 (C指数变化为0.011在3年,NRI为0.016在10年风险),但随着时间的推移,这种改善是有限的和减弱的.
结论:
- 主要EA和多个小EA与老年人心血管疾病事件和死亡率的风险增加有关.
- 虽然EA评分显示了剂量与反应的关系,并显示了风险预测的改善,但其在提高心血管疾病风险预测方面的整体效用是有限的.
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