南京市35岁及以上人群缺血性心血管病10年发病风险评估

王巍巍; 苏健; 洪忻; 杨华凤; 戚圣香; 王琛琛; 周海茸; 李潮; 叶青; 秦真真; 吴洁; 周金意

doi:10.16462/j.cnki.zhjbkz.2021.07.018

南京市35岁及以上人群缺血性心血管病10年发病风险评估

doi: 10.16462/j.cnki.zhjbkz.2021.07.018

1.
210003 南京，南京市疾病预防控制中心慢性非传染病防制科
2.
210009 南京，江苏省疾病预防控制中心慢性非传染病防制所

基金项目:

南京市医学科技发展项目 ZKX18049

南京市医学科技发展项目 YKK17199

详细信息

通讯作者:
周金意，E-mail: zhoujinyi74@sina.com

中图分类号: R714.252
计量
- 文章访问数: 591
- HTML全文浏览量: 437
- PDF下载量: 65
- 被引次数: 0
出版历程
- 收稿日期: 2020-05-30
- 修回日期: 2020-10-17
- 网络出版日期: 2021-08-13
- 刊出日期: 2021-07-10

Prediction of 10-year risk for ischemic cardiovascular disease in adults aged 35 years old and above in Nanjing

1.
Department of Chronic and Non-communicable Disease Control and Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing 210003, China
2.
Department of Chronic and Non-communicable Disease Control and Prevention, Jiangsu Center for Disease Control and Prevention, Nanjing 210009, China

Funds:

Nanjing Municipal Medical Science and Technique Development Foundation ZKX18049

Nanjing Municipal Medical Science and Technique Development Foundation YKK17199

More Information

Corresponding author: ZHOU Jin-yi, E-mail: zhoujinyi74@sina.com

摘要

摘要: 目的了解南京市≥35岁人群缺血性心血管病(ischemia cardiovascular disease, ICVD)10年发病风险。方法采用多阶段分层整群抽样方法，随机抽取南京市≥18岁常住居民61 098名作为调查对象。最终纳入年龄≥35岁且无ICVD病史36 079名作为研究对象。采用《国人ICVD 10年发病风险评估表》评估ICVD发病风险。结果研究对象平均年龄(53.8±11.7)岁，其中男性17 681名，占比49.0%，女性18 398名，占比51.0%。人群ICVD 10年发病风险总得分为(5.1±3.7)分，绝对危险度为2.1%(0.8%~5.4%)；其中发病风险≥10%比例为12.6%，女性高于男性(15.0% vs 10.1%)，且随着年龄的增加而增长，差异均有统计学意义(均有P < 0.001)。ICDV危险因素≥3的人群比例为23.0%，男性高于女性(31.8% vs 14.6%)，差异有统计学意义(χ²=1 509.07, P < 0.001)。男女各危险因素评分在总危险因素评分权重最高分别为吸烟(34.8%)和体重异常(32.5%)。结论南京市≥35岁人群ICVD 10年发病风险高危人群比例已超过10%。需重点关注老年人、体重异常者、高血压者。男性应加强烟草控制，女性应加强体重管理。
- 缺血性心血管病 /
- 危险因素 /
- 风险评估
Abstract: Objective To understand the exposure of risk factors related to Ischemia Cardiovascular Disease (ICVD) in a population aged ≥35 years in Nanjing and to estimate their 10-year risk of ICVD. Methods Multi-stage stratified cluster sampling method was used to randomly select 61 098 permanent residents ≥18 years of age in Nanjing. A total of 36 079 people aged ≥35 years old with no history of ICVD were selected as the study subjects. The "10-year Risk Assessment Table of ICVD in Chinese" was used to assess the risk of ICVD. Results The subjects were (53.8 ± 11.7) years old, including 17 681 men (49.0%) and 18 398 women (51.0%). The score of 10-year risk for ICVD was (5.1 ± 3.7) points, and the absolute risk was 2.1% (0.8%-5.4%); of which, the proportion of ICVD 10-year incidence risk ≥10% was 12.6%, and women were higher than men (15.0% vs 10.1%). Besides, the risk score was found increased with age, and the differences among different age groups were statistically significant (P < 0.001). The proportion of people with ICDV risk factors ≥3 was 23.0%, and the proportion of men is higher than that of women (31.8% vs 14.6%), and the difference was also statistically significant (χ²=1 509.07, P < 0.001). Among the total risk score of ICVD, smoking (34.8%) and BMI (32.5%) accounted for the highest proportion in male and female, respectively. Conclusion The risk of ICVD ≥10% in the population aged ≥35 years old in Nanjing in the next 10 years has exceeded 10%. Attention should be paid to the elderly, abnormal weight and hypertension population. Men should strengthen tobacco control, and women should strengthen weight health management.
- Ischemia cardiovascular disease /
- Risk factors /
- Risk evaluation

HTML全文

表 1 样本人群中ICVD危险因素暴露情况[n(%)]

Table 1. Exposure of ICVD risk factors in the sample population [n(%)]

危险因素	合计(N=36 079)	男性(n=17 681)	女性(n=18 398)	t/χ²值	P值
年龄(岁)	53.8±11.7	53.6±12.0	53.9±11.4	2.07	0.039
SBP(mm Hg)	126.9±14.5	128.7±13.5	125.2±15.1	23.36	< 0.001
BMI(kg/m²)	24.3±3.1	24.7±3.0	24.0±3.3	21.90	< 0.001
TC(mmol/L)	4.8±1.1	4.7±1.1	4.9±1.1	14.96	< 0.001
FPG(mmol/L)	5.5±1.6	5.6±1.7	5.4±1.5	10.33	< 0.001
吸烟	9 222(25.6)	8 932(50.5)	290(1.6)	11 350.09	< 0.001
高收缩压	13 643(37.8)	7 299(41.3)	6 344(34.5)	177.27	< 0.001
高总胆固醇	17 681(49.0)	5 297(30.0)	6 631(36.0)	150.77	< 0.001
体重异常	18 499(51.3)	10 160(57.5)	8 339(45.3)	531.62	< 0.001
糖尿病	4 891(13.6)	2 670(15.1)	2 221(12.1)	70.59	< 0.001

下载: 导出CSV

表 2 样本人群中ICVD 10年发病风险和风险等级分布情况

Table 2. The 10-year incidence and risk distribution of ICVD in the sample population

特征	人数[n(%)]	风险总得分(x±s)	t/F值	P值	绝对危险度(%)M(P₂₅, P₇₅)	H/U值	P值	风险等级(%)			χ²值	P值
特征	人数[n(%)]	风险总得分(x±s)	t/F值	P值	绝对危险度(%)M(P₂₅, P₇₅)	H/U值	P值	高危(≥10)	中危(5~ < 10)	低危(< 5)	χ²值	P值
性别			35.73	< 0.001		41.85	< 0.001				1 867.62	< 0.001
男	17 681(49.0)	5.8±3.6			2.9(1.1, 5.4)			1 777(10.1)	4 012(22.6)	11 892(67.3)
女	18 398(51.0)	4.5±3.7			1.2(0.5, 4.4)			2 764(15.0)	1 263(6.9)	14 371(78.1)
年龄组(岁)			14 144.82	< 0.001		21 482.59	< 0.001				14 796.26	< 0.001
35~ < 45	8 824(24.5)	0.8±1.2			0.5(0.2, 0.8)			15(0.2)	54(0.6)	8 755(99.2)
45~ < 55	10 726(29.7)	2.1±2.5			1.5(0.8, 2.8)			146(1.4)	735(6.8)	9 845(91.8)
55~ < 65	9 821(27.2)	5.0±4.9			3.9(1.8, 6.8)			1 019(10.4)	2 386(24.3)	6 416(65.3)
65~ < 75	4 887(13.5)	11.3±9.2			9.7(5.4, 15.6)			2 077(42.5)	1 653(33.8)	1 157(23.7)
≥75	1 821(5.0)	18.8±12.4			15.6(9.7, 23.0)			1 284(70.5)	447(24.6)	90(4.9)
地区			9.86	< 0.001		8.63	< 0.001				32.21	< 0.001
城区	23 492(65.1)	5.0±3.7			1.8(0.8, 5.4)			2 801(11.9)	3 388(14.4)	17 303(73.7)
郊县	12 587(34.9)	5.4±3.7			2.1(0.8, 5.4)			1 740(13.8)	1 887(15.0)	8 960(71.2)
受教育水平			2 735.77	< 0.001		4 501.42	< 0.001				2 471.90	< 0.001
小学及以下	4 854(13.5)	7.1±3.5			4.4(1.8, 10.3)			1 424(29.3)	864(17.8)	2 566(52.9)
初中/高中	20 932(58.0)	5.7±3.5			2.8(1.1, 5.4)			2 674(12.8)	3 592(17.2)	14 666(70.0)
大专及以上	10 293(28.5)	3.2±3.5			0.8(0.3, 2.1)			443(4.3)	819(8.0)	9 031(87.7)
职业类型			2 309.94	< 0.001		6 983.42	< 0.001				4 972.93	< 0.001
蓝领人员	8 456(23.4)	4.7±3.4			1.8(0.8, 3.9)			606(7.2)	1 118(13.2)	6 732(79.6)
服务人员	3 657(10.1)	3.5±3.1			1.1(0.5, 2.1)			109(3.0)	294(8.0)	3 254(89.0)
白领人员	9 621(26.7)	3.3±3.3			1.1(0.5, 2.1)			289(3.0)	763(7.9)	8 569(89.1)
离退休人员	14 345(39.8)	7.1±3.3			4.4(1.8, 9.7)			3 537(24.7)	3 100(21.6)	7 708(53.7)
家庭年收入(万元/年)			1 169.24	< 0.001		157.86	< 0.001				599.84	< 0.001
低(≤6)	13 277(36.8)	6.4±3.8			2.9(1.2, 7.3)			2 001(15.1)	2 034(15.3)	9 242(69.6)
中(>6~10)	11 906(33.0)	6.3±3.9			2.9(1.1, 7.3)			1 740(14.6)	1 983(16.7)	8 183(68.7)
高(>10)	10 896(30.2)	4.7±3.8			1.5(0.6, 5.4)			800(7.4)	1 258(11.5)	8 838(81.1)
合计	36 079	5.1±3.7			2.1(0.8, 5.4)			4 541(12.6)	5 275(14.6)	26 263(72.8)

下载: 导出CSV

表 3 样本人群中ICVD危险因素聚集分布情况

Table 3. The aggregation of ICVD risk factors in the sample population

特征	危险因素 < 3个	危险因素≥3个	χ²值	P值
性别			1 509.07 ^a	< 0.001
男	12 060(68.2)	5 621(31.8)
女	15 718(85.4)	2 680(14.6)
年龄组(岁)			1 673.64 ^b	< 0.001
35~ < 45	7 899(89.5)	925(10.5)
45~ < 55	8 653(80.7)	2 073(19.3)
55~ < 65	6 960(70.9)	2 861(29.1)
65~ < 75	3 104(63.5)	1 783(36.5)
≥75	1 162(63.8)	659(36.2)
合计	27 778(77.0)	8 301(23.0)
注：^aχ²检验；^b趋势性χ²检验。

下载: 导出CSV

4a 男性不同年龄组人群ICVD各危险因素权重[n(%)]

4a. Weights of risk factors of ICVD in different age groups of male [n(%)]

变量	男性年龄(岁)						χ_趋势²值	P值
变量	35~ < 45	45~ < 55	55~ < 65	65~ < 75	≥75	合计	χ_趋势²值	P值
高收缩压	1 902(18.1)	3 177(22.3)	4 120(27.1)	2 666(32.6)	1 284(40.8)	13 149(25.6)	985.53	< 0.001
体重异常	3 198(30.4)	3 506(24.6)	3 309(21.8)	1 726(21.1)	606(19.3)	12 345(24.1)	303.18	< 0.001
高总胆固醇	1 168(11.1)	1 504(10.5)	1 553(10.2)	780(9.5)	292(9.3)	5 297(10.3)	16.66	< 0.001
吸烟	4 048(38.5)	5 496(38.5)	5 280(34.8)	2 344(28.7)	696(22.1)	17 864(34.8)	431.16	< 0.001
糖尿病	210(2.0)	590(4.1)	934(6.2)	666(8.1)	270(8.6)	2 670(5.2)	480.79	< 0.001

下载: 导出CSV

4b 女性不同年龄组人群ICVD各危险因素权重[n(%)]

4b. Weights of risk factors of ICVD in different age groups of female [n(%)]

变量	女性年龄(岁)						χ_趋势²值	P值
变量	35~ < 45	45~ < 55	55~ < 65	65~ < 75	≥75	合计	χ_趋势²值	P值
高收缩压	778(22.8)	2 650(30.6)	3 400(31.4)	2 259(35.3)	963(39.4)	10 050(31.6)	209.10	< 0.001
体重异常	1 534(45.0)	3 159(36.4)	3 243(30.0)	1 819(28.5)	568(23.2)	10 323(32.5)	435.97	< 0.001
高总胆固醇	785(23.1)	1 995(23.0)	2 439(22.6)	1 066(16.7)	346(14.2)	6 631(20.9)	138.24	< 0.001
吸烟	65(1.9)	82(1.0)	70(0.7)	37(0.6)	36(1.5)	290(0.9)	12.17	< 0.001
糖尿病	244(7.2)	788(9.1)	1 666(15.4)	1 212(19.0)	532(21.8)	4 442(14.0)	554.18	< 0.001

下载: 导出CSV

参考文献(15)

[1]	胡盛寿, 高润霖, 刘力生, 等. 《中国心血管病报告2018》概要[J]. 中国循环杂志, 2019, 34(3): 209-220. DOI: 10.3969/j.issn.1000-3614.2019.03.001. Hu SS, Gao RL, Liu LS, et al. Summary of the 2018 report on cardiovascular diseases in China[J]. Chinese Circulation Journal, 2019, 34(3): 209-220. DOI: 10.3969/j.issn.1000-3614.2019.03.001.
[2]	Wu Y, Liu X, Li X, et al. Estimation of 10-year risk of fatal and nonfatal ischemic cardiovascular diseases in Chinese adults[J]. Circulation, 2006, 114(21): 2217-2225. DOI: 10.1161/circulationaha.105.607499.
[3]	Yang L, Fish AF, Zhu Y, et al. Sex differences in 10-year ischemic cardiovascular disease risk prediction in Chinese patients with prediabetes and type 2 diabetes[J]. BMC Cardiovasc Disord, 2019, 19(1): 301. DOI: 10.1186/s12872-019-1232-y.
[4]	中国高血压防治指南修订委员会高血压联盟, 中华医学会心血管病学分会, 中国医师协会高血压专业委员会, 等. 中国高血压防治指南(2018年修订版)[J]. 中国心血管杂志, 2019, 24(1): 24-56. DOI: 10.3969/j.issn.1007-5410.2019.01.002. Chinese Guidelines for the Management of Hypertension, Chinese Hypertension League, Chinese Society of Cardiology, Chinese Medical Doctor Association Hypertension Committee, Hypertension Branch of China, et al. 2018 Chinese guidelines for the management of hypertension[J]. Chin J Cardiovasc Med, 2019, 24(1): 24-56. DOI: 10.3969/j.issn.1007-5410.2019.01.002.
[5]	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2017年版)[J]. 中华糖尿病杂志, 2018, 10(1): 4-67. DOI: 10.3760/cma.j.issn.1674-5809.2018.01.003. Chinese Society of Diabetes. 2017 Chinese guidelines for the management of type 2 diabetes[J]. Chin J Diabetes Mellitus, 2018, 10(1): 4-67. DOI: 10.3760/cma.j.issn.1674-5809.2018.01.003.
[6]	中国成人血脂异常防治指南修订联合委员会. 中国成人血脂异常防治指南(2016年修订版)[J]. 中国循环杂志, 2016, 31(10): 937-953. DOI: 10.3969/j.issn.1000-3614.2016.10.002. Writing Group of Chinese Guidelines for the Management of Dyslipidemia in Adults. Chinese guidelines for the management of dyslipidaemias in adults (2016 Revised Edition)[J]. Chinese Circulation Journal, 2016, 31(10): 937-953. DOI: 10.3969/j.issn.1000-3614.2016.10.002.
[7]	Zhou BF, Cooperative Meta-Analysis Group of the Working Group on Obesity in China. Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults: study on optimal cut-off points of body mass index and waist circumference in Chinese adults[J]. Biomed Environ Sci, 2002, 15(1): 83-96. DOI: 10.1046/j.1440-6047.11.s8.9.x.
[8]	Yang G, Fan L, Tan J, et al. Smoking in China: findings of the 1996 national prevalence survey[J]. JAMA, 1999, 282: 1247-1253. DOI: 10.1001/jama.282.13.1247.
[9]	张梅, 黄正京, 李镒冲, 等. 中国35岁及以上人群缺血性心血管病10年发病风险预测[J]. 中华流行病学杂志, 2016, 37(5): 689-693. DOI: 10.3760/cma.j.issn.0254-6450.2016.05.021. Zhang M, Huang ZJ, Li YC, et al. Prediction of 10-year risk for ischemic cardiovascular disease in adults aged ≥35 years in China[J]. Chin J Epidemiol, 2016, 37(5): 689-693. DOI: 10.3760/cma.j.issn.0254-6450.2016.05.021.
[10]	陈一佳, 苏健, 覃玉, 等. 江苏省两城市35岁及以上2型糖尿病患者缺血性心血管病10年发病风险评估[J]. 中华预防医学杂志, 2019(2): 218-222. DOI: 10.3760/cma.j.issn.0253-9624.2019.02.018. Chen YJ, Su J, Qin Y, et al. Evaluation of 10-year risk for ischemic cardiovascular disease in type 2 diabetes aged 35 years old and above in two cities of Jiangsu Province[J]. Chin J Prev Med, 2019(2): 218-222. DOI: 10.3760/cma.j.issn.0253-9624.2019.02.018.
[11]	Xu F, Yin XM, Zhang M, et al. Family average income and diagnosed type 2 diabetes in urban and rural residents in regional mainland China[J]. Diabet Med, 2006, 23(11): 1239-1246. DOI: 10.1111/j.1464-5491.2006.01965.x.
[12]	Wang L, Gao P, Zhang M, et al. Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013[J]. JAMA, 2017, 317(24): 2515-2523. DOI: 10.1001/jama.2017.7596.
[13]	陆凤, 赵鸣, 胡如英, 等. 浙江省高血压患者心血管病危险分层评估现状分析[J]. 中华流行病学杂志, 2014, 35(11): 1231-1234. DOI: 10.3760/cma.j.issn.0254-6450.2014.11.012. Lu F, Zhao M, Hu RY, et al. Current status regarding the levels of risks on cardiovascular diseases among the hypertensives in Zhejiang[J]. Chin J Epidemiol, 2014, 35(11): 1231-1234. DOI: 10.3760/cma.j.issn.0254-6450.2014.11.012.
[14]	徐松波. 中国中老年人心血管系统疾病危险因素及聚集[J]. 中国老年学杂志, 2018, 38(12): 2819-2822. DOI: 10.3969/j.issn.1005-9202.2018.12.002. Xu SB. Risk factors and clustering of risk factors for cardiovascular disease among middle-aged and elderly people in China[J]. Chin J Gerontol, 2018, 38(12): 2819-2822. DOI: 10.3969/j.issn.1005-9202.2018.12.002.
[15]	严青华, 张夏芸, 徐继英, 等. 上海市35~59岁人群缺血性心血管病10年发病风险评估[J]. 中国公共卫生, 2019, 35(9): 1183-1186. DOI: 10.11847/zgggws1122521. Yan QH, Zhang XY, Xu JY, et al. Assessment of 10-year risk for ischemic cardiovascular disease for adults aged 35-59 years in Shanghai City[J]. Chin J Public Health, 2019, 35(9): 1183-1186. DOI: 10.11847/zgggws1122521.