老年人群可改变心血管危险因素聚集模式与脑卒中的关联

doi:10.6040/j.issn.1671-7554.0.2024.1421

摘要/Abstract

摘要： 目的探索山东省不同性别老年人群中可改变心血管危险因素(modifiable cardiovascular risk factors, MCVRFS)的聚集模式,并评估其与脑卒中发生的关联性。方法基于齐鲁全生命周期电子健康研究型数据库(Cheeloo Lifespan Electronic Health Research Data-library, Cheeloo LEAD),纳入2015年6月1日至12月31日期间具有完整健康体检记录、电子病历记录和公共卫生建档记录的≥60岁老年人,构建包含58 633名参与者的随访队列,随访期为7年,研究终点为脑卒中事件。通过潜在类别分析(latent class analysis, LCA)探索MCVRFS的聚集模式,采用Cox比例风险回归模型评估不同聚集模式与脑卒中的关联性。结果本研究通过LCA在不同性别亚群中均识别出4种MCVRFS聚集模式。男性人群低风险组、吸烟饮酒组、超重肥胖组和代谢综合征组的占比分别为39.02%、16.41%、36.34%和8.22%;女性人群中,低风险组、吸烟饮酒组、体质量及血脂异常组和代谢综合征组的占比分别为41.00%、0.44%、46.76%和11.80%。男性人群中,新发脑卒中6 764例,发病密度为0.04 947/人年;女性新发脑卒中8 141例,发病密度为0.04 273/人年。校正混杂因素后,Cox回归结果显示,男性人群中,吸烟饮酒组、超重肥胖组、代谢综合征组发生脑卒中的风险分别为低风险组的1.13倍(HR=1.13,95%CI=1.05~1.21)、1.16倍(HR=1.16,95%CI=1.09~1.23)和2.20倍(HR=2.20,95%CI=2.04~2.38);女性人群中,体质量及血脂异常组和代谢综合征组发生脑卒中的风险分别为低风险组的1.16倍(HR=1.16,95%CI=1.10~1.21)和2.39倍(HR=2.39,95%CI=2.25~2.54)。结论本研究在山东省不同性别老年人群中均识别出4种MCVRFS的聚集模式,男性人群中,超重肥胖组、吸烟饮酒组和代谢综合征组均增加脑卒中风险;女性人群中,体质量及血脂异常组和代谢综合征组均增加脑卒中发生风险。针对不同聚集模式的个体化干预策略可能有助于降低老年人脑卒中的发生率,减轻其疾病负担。

关键词: 脑卒中, 可改变心血管危险因素, 山东省, 老年人, 队列研究, 潜在类别分析, 生存分析

Abstract: Objective To explore the gender-specific clustering patterns of modifiable cardiovascular risk factors(MCVRFS)and assess their associations with stroke incidence among the elderly population in Shandong Province. Methods Based on the Cheeloo Lifespan Electronic Health Research Data-library(Cheeloo LEAD)database, 58,633 participants aged ≥60 years old with complete health examination records, electronic medical records, and public health archives from June 1 to December 31, 2015 were included. A seven-year follow-up cohort was constructed, with occurence of stroke as the study endpoint. Latent class analysis(LCA)was used to identify MCVRFS clustering patterns, and Cox proportional hazards regression models were applied to evaluate associations between clusters and stroke risk. Results LCA identified four MCVRFS clusters in both genders. Males comprised the low-risk(39.02%), smoking and alcohol consumption(16.41%), overweight/obesity(36.34%), and metabolic syndrome(8.22%)groups. Females comprised the low-risk(41.00%), smoking and alcohol consumption(0.44%), overweight and dyslipidemia(46.76%), and metabolic syndrome(11.80%)groups. During follow-up, 6,764 new stroke cases occurred in males(incidence density: 4,947/100,000 person-years)and 8,141 in females(incidence density: 4,273/100,000 person-years). Adjusted Cox regression showed that males in smoking and alcohol consumption group(HR=1.13, 95%CI=1.05-1.21), overweight obesity group(HR=1.16, 95%CI=1.09-1.23), and metabolic syndrome group(HR=2.20, 95%CI=2.04-2.38)had elevated stroke risks compared to the low-risk group. In females, overweight and dyslipidemia group(HR=1.16, 95%CI=1.10-1.21)and metabolic syndrome group(HR=2.39, 95%CI=2.25-2.54)showed higher stroke risks compared to the low-risk group. Conclusion Four kinds of gender-specific MCVRFS clustering patterns are identified in Shandongs elderly population. Overweight-obesity, smoking-alcohol, and metabolic syndrome clusters increase stroke risk in males, while weight-dyslipidemia and metabolic syndrome clusters elevate risks in females. Targeted intervention strategies tailored to these clusters may reduce stroke incidence and disease burden in the elderly.

Key words: Stroke, Modifiable cardiovascular risk factors, Shandong Province, Elderly, Cohort study, Latent class analysis, Survival analysis

中图分类号:

R195

逄锦宏,苏萍,乔俊鹏,陈巧巧,陈学禹,赵颖颖,施婕,孙晓茹,李秋春,何蕊言,范轶欧,迟蔚蔚. 老年人群可改变心血管危险因素聚集模式与脑卒中的关联[J]. 山东大学学报 (医学版), 2025, 63(9): 11-19.

PANG Jinhong, SU Ping, QIAO Junpeng, CHEN Qiaoqiao, CHEN Xueyu, ZHAO Yingying, SHI Jie, SUN Xiaoru, LI Qiuchun, HE Ruiyan, FAN Yiou, CHI Weiwei. Association between modifiable cardiovascular risk factors clustering patterns and stroke in the elderly population[J]. Journal of Shandong University (Health Sciences), 2025, 63(9): 11-19.

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