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Looking 'old for years' boosts cardiovascular risk面相老的人心血管风险高  

2013-01-23 18:24:48|  分类: 心血管科 |  标签: |举报 |字号 订阅

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洛杉矶——美国心脏协会(AHA)年会上公布的标志性哥本哈根市心脏研究显示,面相老的人的冠状动脉可能也在加速老化。

Looking old for years boosts cardiovascular risk面相老的人心血管风险高 - gloryking3 - gloryking3的博客
Anne Tybjaerg-Hansen博士


在这项由哥本哈根大学Anne Tybaerg-Hansen博士及其同事进行的前瞻性研究中,近11,000例患者在1976~1978年进行首次体检,当时研究者不知晓患者的健康状态和根据预定标准系统记录的可见老化体征。从那以后,在平均随访35年间,这些患者共发生3,401起缺血性心脏事件,包括1,708起急性心肌梗死(MI)。


广泛校正潜在混杂因素的多因素分析证实,一些典型的老化体征与远期缺血性心脏病风险无关。皱纹、灰发和角膜弓(眼中有胆固醇沉积)均不与风险独立相关。


然而,在校正年龄、性别、所有标准心血管危险因素、社会经济地位、体重指数和体力活动后,发现4个老化体征仍是风险增加的独立预测因素。睑黄瘤(眼睑周围有黄色的胆固醇沉积物)与随访期间MI风险增加35%相关。耳垂折痕与风险显著增加11%相关。冠顶秃头导致相对风险增加40%,额顶秃头与风险增加14%相关。


只有在男性中,这两种类型的秃头才是风险增加的显著预测因素。在女性中,冠顶秃头和额顶秃头也与MI风险增加相关,但不具有统计学显著性,原因是出现这些老化体征的女性数量太少。


基线时4种老化体征越多见,之后发生急性MI的风险越高。9%的患者存在3种或所有4种老化体征,校正后的分析显示,这些患者的急性MI风险比无老化体征的患者高60%。存在1种或2种老化体征者的风险分别增加20%和35%。


在所有年龄组(每组年龄跨度为10岁)中,均观察到风险随老化体征数量增加的趋势。例如,在70~79岁男性中,存在3种或4种老化体征者的10年绝对缺血性心脏病风险为44%,而无老化体征者的风险为32%。


有与会者询问老化体征与缺血性心脏病之间关联的潜在机制,Tybjaerg-Hansen博士回应表示,目前基本上没有可供指导的科学数据。但有研究显示高游离睾酮水平与男性秃头相关,并且一些研究发现游离睾酮与缺血性心脏病相关。此外,Tybjaerg-Hansen博士及其同事近期发现,与睑黄瘤相关的缺血性心脏病风险增加无法通过血清胆固醇或甘油三酯水平加以解释(BMJ 2011;343:d5497)。她表示,可能是结缔组织中的某种物质导致一些患者易于积累胆固醇。结缔组织也可能与耳垂折痕的形成相关,但目前尚无这方面的确凿证据。


Tybjaerg-Hansen博士声明无经济利益冲突。



By: BRUCE JANCIN, Cardiology News Digital Network


LOS ANGELES – If you look old for your chronologic age, chances are your coronary arteries are undergoing accelerated biologic aging, too, judging from findings in a new report from the landmark Copenhagen City Heart Study.


Several specific skin signs of aging serve as significant predictors of increased risk for ischemic heart disease independent of chronologic age and the standard cardiovascular risk factors, Dr. Anne Tybaerg-Hansen reported at the annual scientific sessions of the American Heart Association.

"I think this is pretty useful information clinically. If you look at your patients right, it’ll give you an idea of their cardiovascular health independent of their chronologic age. And when you see these traits that are not dependent on the well-known cardiovascular risk factors, then you should perhaps treat them more diligently, because their 10-year risk is higher than in individuals in the same age groups who do not have these aging signs," explained Dr. Tybjaerg-Hansen, professor of clinical biochemistry at the University of Copenhagen.


When nearly 11,000 participants in the prospective Copenhagen City Heart Study had their first physical examination back in 1976-1978, investigators blinded as to subjects’ health status systematically recorded visible signs of aging using prespecified criteria. Since then, during a mean follow-up of 35 years, there have been 3,401 ischemic heart disease events, including 1,708 acute MIs, in these subjects.


In a multivariate analysis extensively adjusted for potential confounders, several classic signs of aging proved unrelated to the risk of future ischemic heart disease. Neither wrinkles, grey hair, nor arcus corneae – that is, cholesterol deposits in the eye – were independently related to risk. That implies these features are fully accounted for by chronologic age and conventional cardiovascular risk factors.


However, four aging signs remained independent predictors of increased risk after controlling for age, gender, all the standard cardiovascular risk factors, socioeconomic status, body mass index, and physical activity. Xanthelasma – yellowish deposits of cholesterol around the eyelids – was associated with a 35% increased risk of MI during follow-up. An earlobe crease was associated with a significant 11% increased risk. Crown top baldness carried a 40% increase in relative risk, while frontoparietal baldness was associated with a 14% greater risk.


These two forms of baldness were significant predictors in men only. Crown top and frontoparietal baldness also were linked to increased MI risk in women, but this association didn’t achieve statistical significance because so few women experience these aging signs.


The more of the four aging signs present at baseline, the greater the risk of subsequent acute MI. Nine percent of subjects had three or all four aging signs; their risk of acute MI was 60% greater than in individuals with none of the aging signs in the adjusted analysis. Those with one or two aging signs had increased risks of roughly 20% and 35%, respectively.


This stepwise increase in risk held true across all 10-year age groups. Among 70- to 79-year-old men, for example, those with three or four of the aging signs had a 44% absolute 10-year risk of ischemic heart disease, while those with none of the signs had a 32% risk.


Asked to speculate about the mechanisms underlying the association between the aging signs and ischemic heart disease, Dr. Tybjaerg-Hansen was quick to note that "there are no scientific data at all" for guidance. That being said, high free-testosterone levels are associated with male-pattern baldness, and some studies have reported a link between free testosterone and ischemic heart disease. Also, Dr. Tybjaerg-Hansen and her coworkers recently demonstrated that the increased risk of ischemic heart disease associated with xanthelasma cannot be explained by serum cholesterol or triglyceride levels (BMJ 2011;343:d5497).
 
"So there must be something else, probably something in the connective tissue, which makes some people more prone to accumulate cholesterol. Connective tissue could also be involved in the earlobe crease. But there is as yet no hard evidence for this," she said.


Session chair Dr. Kathy Magliato, a cardiothoracic surgeon and director of women’s cardiac services at St. John’s Health Center in Los Angeles, said that the new Copenhagen City Heart Study findings confirm her own anecdotal experience.


"The majority of people who come to me because they’ve missed out on the benefits of prevention and now need heart surgery look old for their age. It’s reassuring to know now that I’m not just imagining that. The older they look, the worse their heart disease," she said.


"This study reinforces the fact that we have to look at our patients," Dr. Magliato continued. "I think doctors are sometimes so rushed to put on a blood pressure cuff and get a stethoscope on the chest that we forget to just step back and look at these visible signs of aging."


Dr. Tybjaerg-Hansen reported having no financial conflicts.


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