JAMA：基于尸检的研究对美军中动脉粥样硬化的发病率进行了检查

据发表在12月26日出版的《美国医学会杂志》上的一项研究披露，在那些于2001-2011年间死于战斗或意外伤害并进行了尸体解剖的派驻美国军人中，冠状动脉粥样硬化的患病率为8.5%，与该疾病较高的患病率有关的因子包括：较大的年龄、较低的教育水平及先前确诊过的血脂异常、高血压及肥胖症。

马里兰州贝塞斯达国防医科大学的Bryant J. Webber, M.D.及其同事开展了一项研究，旨在评估美军中动脉粥样硬化的发病率。这项研究包括了在2001年10月至2011年8月间因支持持久自由行动和伊拉克自由/新曙光行动而在战斗中死亡或意外受伤死亡的所有美国军人，且研究人员在2012年1月采集数据时获得了他们尸检的心血管报告。动脉粥样硬化患病率是通过不同的人口特征及病历进行分析的。冠状动脉粥样硬化的严重程度的分类是在数据分析前确定的，而且这种分类被设计成与先前的军中的研究保持连贯性：最小程度（只有脂性条纹）、中度（1或多根血管管腔[血管内部]变窄10-49%）及重度（1或多根血管管腔变窄50%或以上）。纳入这项研究的有3832名军人，其平均年龄为26岁。

冠状动脉或主动脉粥样硬化的总患病率为12.1%。任何程度的冠状动脉粥样硬化的患病率为8.5%；重度冠状动脉粥样硬化率为2.3%，中度冠状动脉粥样硬化率为4.7%，最小冠状动脉粥样硬化率为1.5%。研究人员发现，年龄一直与流行的动脉粥样硬化有着最强的相关性。有动脉粥样硬化的军人（平均年龄30.5岁）比那些没有动脉粥样硬化的军人大约年长5岁。与那些年龄为24岁或以下的人相比，那些年龄在40岁或以上的人的患病率要高出大约7倍。

较低的教育水平以及较高的入伍时身体质量指数（BMI）在经过年龄较正后与流行的动脉粥样硬化具有显著的相关性。与那些完成了高中或以下教育的人相比，那些至少上过一段时间大学的人有着较低的患病率。与那些在入伍时有着正常BMI的人相比，那些BMI在超重或肥胖范围内的人有着较高的动脉粥样硬化的患病率。

文章的作者还发现，经过年龄校正的动脉粥样硬化患病率与数种诊断相关。与那些没有主要的心血管风险因子诊断者相比，那些被确诊有血脂异常（50.0% vs. 11.1%）、高血压（43.6% vs. 11.1%）或肥胖症（22.3% vs. 11.1%）的人有着显著较高的动脉粥样硬化的患病率。

研究人员写道，与韩战中的77%和越战中的45%的患病率相比，这一研究发现的该病的患病率有所下降，但他们补充说，仍然可以做到进一步的改善。

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Prevalence of and Risk Factors for Autopsy-Determined Atherosclerosis Among US Service Members, 2001-2011
ABSTRACT
Context Autopsies of US service members killed in the Korean and Vietnam wars demonstrated that atherosclerotic changes in the coronary arteries can appear early in the second and third decades of life, long before ischemic heart disease becomes clinically apparent. Objective To estimate the current prevalence of coronary and aortic atherosclerosis in the US armed forces. Design, Setting, and Participants Cross-sectional study of all US service members who died of combat or unintentional injuries in support of Operations Enduring Freedom and Iraqi Freedom/New Dawn between October 2001 and August 2011 and whose cardiovascular autopsy reports were available at the time of data collection in January 2012. Prevalence of atherosclerosis was analyzed by various demographic characteristics and medical history. Classifications of coronary atherosclerosis severity were determined prior to data analysis and designed to provide consistency with previous military studies: minimal (fatty streaking only), moderate (10%-49% luminal narrowing of ≥1 vessel), and severe (≥50% narrowing of ≥1 vessel). Main Outcome Measures Prevalence of coronary and aortic atherosclerosis in the US armed forces and by age, sex, self-reported race/ethnicity, education, occupation, service branch and component, military rank, body mass index at military entrance, and International Classification of Diseases, Ninth Revision, Clinical Modification, diagnoses of cardiovascular risk factors. Results Of the 3832 service members included in the analysis, the mean age was 25.9 years (range, 18-59 years) and 98.3% were male. The prevalence of any coronary atherosclerosis was 8.5% (95% CI, 7.6%-9.4%); severe coronary atherosclerosis was present in 2.3% (95% CI, 1.8%-2.7%), moderate in 4.7% (95% CI, 4.0%-5.3%), and minimal in 1.5% (95% CI, 1.1%-1.9%). Service members with atherosclerosis were significantly older (mean [SD] age, 30.5 [8.1] years) than those without (mean [SD] age, 25.3 [5.6] years; P < .001). Comparing atherosclerosis prevalence among with those with no cardiovascular risk factor diagnoses (11.1% [95% CI, 10.1%-12.1%]), there was a greater prevalence among those with a diagnosis of dyslipidemia (50.0% [95% CI, 30.3%-69.7%]; age-adjusted prevalence ratio [PR], 2.09 [95% CI, 1.43-3.06]), hypertension (43.6% [95% CI, 27.3%-59.9%]; age-adjusted PR, 1.88 [95% CI, 1.34-2.65]), or obesity (22.3% [95% CI, 15.9%-28.7%]; age-adjusted PR, 1.47 [95% CI, 1.10-1.96]), but smoking (14.1% [95% CI, 8.0%-20.2%]) was not significantly associated with a higher prevalence of atherosclerosis (age-adjusted PR, 1.12 [95% CI, 0.73-1.74]). Conclusion Among deployed US service members who died of combat or unintentional injuries and received autopsies, the prevalence of atherosclerosis varied by age and cardiovascular risk factors.

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