Clin Res Cardiol:性别、年龄和种族对糖尿病合并急性冠脉综合征患者冠状动脉和心力衰竭事件的影响

2021-05-02 Nebula MedSci原创

老年和非白人患者发生心力衰竭的风险较高,在女性中有更明显的趋势,而只有非白人患者发生MACE的风险更高

女性、老年患者和非白人族群经历了相当大比例的急性冠脉综合征(ACS),虽然他们在ACS随机临床试验(RCT)中的代表性历来偏低。

为了评估性别、年龄和种族对主要不良血管事件(MACE)和心力衰竭事件的影响,本研究在一项大型的ACS后试验中研究了2型糖尿病患者(EXTEST)。

采用未校正和校正的Cox回归模型,对ACS后的糖尿病患者的基线特征和心血管死亡、非致命性心肌梗死或非致命性卒中(MACE)和心血管死亡或心力衰竭住院(HF事件)的各个复合终点的差异进行分组评估。

MACE和HF事件结果

总体上,该试验共纳入了5380名患者,其中35%的患者在65岁以上,32%的患者为女性,27%的患者为非白人。调整了潜在的混杂因素后,非白人患者发生MACE的风险高于白人患者(HR 1.35;95%CI 1.04~1.75),但性别和年龄差异无显著性(女性:HR 1.03;95%CI 0.87~1.22;年龄>65岁:HR 1.14;95%CI 0.96~1.35)。非白人(HR 1.56;95%CI 1.13~2.14)、>65岁(HR 1.33;95%CI 1.07~1.66)和女性患者(HR 1.23;95%CI 0.99~1.52)发生HF事件的风险性较高。

与MACE相比,每种人口统计因素(女性、高龄和非白人)在心力衰竭事件中的附加风险更大。此外,无论男女,非白人老年患者的预后一直较差。

总之,ACS后的老年人、女性和非白人糖尿病患者在随机对照试验中的代表性往往较低。老年和非白人患者发生心力衰竭的风险较高,在女性中有更明显的趋势,而只有非白人患者发生MACE的风险更高(女性和老年患者的风险无明显差异)。未来的试验应该注意增加这些高危人群的招募人数。

原始出处:

Rossello Xavier,Ferreira Jo?o Pedro,Caimari Francisca et al. Influence of sex, age and race on coronary and heart failure events in patients with diabetes and post-acute coronary syndrome. Clin Res Cardiol, 2021, https://doi.org/10.1007/s00392-021-01859-2

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    2021-05-03 ms6000002109263869

    学习了

    0

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    2021-05-02 misszhang

    谢谢MedSci提供最新的资讯

    0

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    2021-05-02 ms7000001689976839

    好东西-学习学习

    0

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