哈佛大学公共卫生学院（HSPH）领衔的一项研究证实，世界范围里，高血压仍然是心血管疾病（CVD）的首要致病因子。该项研究对全球1980～2010年期间，血压、胆固醇、葡萄糖和肥胖四个因素对CVD、慢性肾病和糖尿病死亡率产生的影响进行了评估。该研究成果5月19日刊载在The Lancet Endocrinology & Diabetes杂志上。
该研究发现，这四个因素与全球范围里心血管疾病63%死亡率相关，不过各地区也存在较大差异。中低收入国家特别是东亚和东南亚、中亚和东欧，这四个风险因子是心血管疾病导致的死亡病例的82%；在南亚和撒哈拉以南非洲以南地区，70岁以下心血管疾病人群因这四个风险因子导致的早死率分别为55%和58%。
自1980年，全球高身体质量指标（BMI）增加一倍。尽管有效药物成本较低，高血压仍然是全球CVD最大的代谢风险因子，且也是大多数地区的CVD最大的代谢风险因子。
游文娟 编译自
https://www.hsph.harvard.edu/news/hsph-in-the-news/high-blood-pressure-top-risk-factor-in-heart-disease-deaths/
参考文献：
Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment
Summary：
Background
High blood pressure, blood glucose, serum cholesterol, and BMI are risk factors for cardiovascular diseases and some of these factors also increase the risk of chronic kidney disease and diabetes. We estimated mortality from cardiovascular diseases, chronic kidney disease, and diabetes that was attributable to these four cardiometabolic risk factors for all countries and regions from 1980 to 2010.
Methods
We used data for exposure to risk factors by country, age group, and sex from pooled analyses of population-based health surveys. We obtained relative risks for the effects of risk factors on cause-specific mortality from meta-analyses of large prospective studies. We calculated the population attributable fractions for each risk factor alone, and for the combination of all risk factors, accounting for multicausality and for mediation of the effects of BMI by the other three risks. We calculated attributable deaths by multiplying the cause-specific population attributable fractions by the number of disease-specific deaths. We obtained cause-specific mortality from the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We propagated the uncertainties of all the inputs to the final estimates.
Findings
In 2010, high blood pressure was the leading risk factor for deaths due to cardiovascular diseases, chronic kidney disease, and diabetes in every region, causing more than 40% of worldwide deaths from these diseases; high BMI and glucose were each responsible for about 15% of deaths, and high cholesterol for more than 10%. After accounting for multicausality, 63% (10·8 million deaths, 95% CI 10·1—11·5) of deaths from these diseases in 2010 were attributable to the combined effect of these four metabolic risk factors, compared with 67% (7·1 million deaths, 6·6—7·6) in 1980. The mortality burden of high BMI and glucose nearly doubled from 1980 to 2010. At the country level, age-standardised death rates from these diseases attributable to the combined effects of these four risk factors surpassed 925 deaths per 100 000 for men in Belarus, Kazakhstan, and Mongolia, but were less than 130 deaths per 100 000 for women and less than 200 for men in some high-income countries including Australia, Canada, France, Japan, the Netherlands, Singapore, South Korea, and Spain.
Interpretation
The salient features of the cardiometabolic disease and risk factor epidemic at the beginning of the 21st century are high blood pressure and an increasing effect of obesity and diabetes. The mortality burden of cardiometabolic risk factors has shifted from high-income to low-income and middle-income countries. Lowering cardiometabolic risks through dietary, behavioural, and pharmacological interventions should be a part of the global response to non-communicable diseases.
Funding
UK Medical Research Council, US National Institutes of Health.
