创作:Epi汪 审核:Epi汪 2019年06月14日
  • 纳入1973-1994年瑞典国家出生队列研究中214万余名新生儿数据,随访到2015年;
  • 队列中共有1921名(0.09%)研究对象诊断为缺血性心脏病(IHD);
  • 出生孕周与成年时期IHD发病风险呈反比;
  • 早产(<37周)、早出生(37-38周)儿,在30-43岁时发生IHD的风险较足月儿分别高1.53、1.19倍;
  • 早产的女性IHD总体发病率虽较男性低,但其与非早产儿相比,发病风险的提高较男性大;
  • 兄弟姐妹分析提示,这种关联不是由于基因或者家庭内环境因素引起的。
JAMA Pediatrics [IF:13.946]

Association of Preterm Birth With Risk of Ischemic Heart Disease in Adulthood



2019-06-03, Article

Abstract & Authors:展开

Importance: Preterm birth has previously been associated with increased risks of hypertension and diabetes, but not ischemic heart disease (IHD), in adulthood. The reasons for this lack of association with IHD despite associations with its risk factors have been elusive, but may be associated with methodologic issues, such as survivor bias, in prior studies.
Objective: To determine whether preterm birth is associated with an increased risk of IHD in adulthood in a large population-based cohort.
Design, Setting, and Participants: This national, population-based cohort study included all 2 141 709 persons who were born as singleton live births in Sweden during 1973 to 1994. The data were analyzed in September 2018.
Exposures: Gestational age at birth, identified from nationwide birth records in the Swedish Birth Registry.
Main Outcomes and Measures: Ischemic heart disease that was identified from nationwide inpatient and outpatient diagnoses through 2015 (maximum age, 43 years). A Cox regression was used to examine gestational age at birth in association with IHD in adulthood while adjusting for other perinatal and maternal factors. Cosibling analyses assessed for potential confounding by unmeasured shared familial factors.
Results: Of 2 141 709 participants, 1 041 906 (48.6%) were female and there were 1921 persons (0.09%) who received a diagnosis of IHD in 30.9 million person-years of follow-up. Gestational age at birth was inversely associated with IHD risk in adulthood. At ages 30 to 43 years, adjusted hazard ratios for IHD associated with preterm (gestational age <37 weeks) and early-term birth (37-38 weeks) were 1.53 (95% CI, 1.20-1.94) and 1.19 (1.01-1.40), respectively, compared with full-term birth (39-41 weeks). Preterm-born women had lower IHD incidence than preterm-born men (15.16 vs 22.00 per 100 000 person-years) but had a higher adjusted hazard ratio (1.93; 95% CI, 1.28-2.90 vs 1.37; 95% CI, 1.01-1.84). These associations did not appear to be explained by shared genetic or environmental factors in families.
Conclusions and Relevance: In this large national cohort, preterm and early-term birth were associated with an increased IHD risk in adulthood. Persons born prematurely need early evaluation and preventive actions to reduce the risk of IHD.

First Authors:
Casey Crump

Correspondence Authors:
Casey Crump

All Authors:
Casey Crump,Elizabeth A Howell,Annemarie Stroustrup,Mary Ann McLaughlin,Jan Sundquist,Kristina Sundquist