当代老年队列中初发心力衰竭的流行病学：健康、衰老与身体成分研究
Epidemiology of incident heart failure in a contemporary elderly cohort: the health, aging, and body composition study.
作者信息
Kalogeropoulos Andreas, Georgiopoulou Vasiliki, Kritchevsky Stephen B, Psaty Bruce M, Smith Nicholas L, Newman Anne B, Rodondi Nicolas, Satterfield Suzanne, Bauer Douglas C, Bibbins-Domingo Kirsten, Smith Andrew L, Wilson Peter W F, Vasan Ramachandran S, Harris Tamara B, Butler Javed
机构信息
Cardiology Division, Emory University Hospital, Emory University, 1365 Clifton Rd NE, Ste AT430, Atlanta, GA 30322, USA.
出版信息
Arch Intern Med. 2009 Apr 13;169(7):708-15. doi: 10.1001/archinternmed.2009.40.
BACKGROUND
The race- and sex-specific epidemiology of incident heart failure (HF) among a contemporary elderly cohort are not well described.
METHODS
We studied 2934 participants without HF enrolled in the Health, Aging, and Body Composition Study (mean [SD] age, 73.6 [2.9] years; 47.9% men; 58.6% white; and 41.4% black) and assessed the incidence of HF, population-attributable risk (PAR) of independent risk factors for HF, and outcomes of incident HF.
RESULTS
During a median follow-up of 7.1 years, 258 participants (8.8%) developed HF (13.6 cases per 1000 person-years; 95% confidence interval, 12.1-15.4). Men and black participants were more likely to develop HF. No significant sex-based differences were observed in risk factors. Coronary heart disease (PAR, 23.9% for white participants and 29.5% for black participants) and uncontrolled blood pressure (PAR, 21.3% for white participants and 30.1% for black participants) carried the highest PAR in both races. Among black participants, 6 of 8 risk factors assessed (smoking, increased heart rate, coronary heart disease, left ventricular hypertrophy, uncontrolled blood pressure, and reduced glomerular filtration rate) had more than 5% higher PAR compared with that among white participants, leading to a higher overall proportion of HF attributable to modifiable risk factors in black participants vs white participants (67.8% vs 48.9%). Participants who developed HF had higher annual mortality (18.0% vs 2.7%). No racial difference in survival after HF was noted; however, rehospitalization rates were higher among black participants (62.1 vs 30.3 hospitalizations per 100 person-years, P < .001).
CONCLUSIONS
Incident HF is common in older persons; a large proportion of HF risk is attributed to modifiable risk factors. Racial differences in risk factors for HF and in hospitalization rates after HF need to be considered in prevention and treatment efforts.
背景
当代老年队列中心力衰竭（HF）的种族和性别特异性流行病学尚未得到充分描述。
方法
我们研究了2934名未患HF的健康、衰老和身体成分研究参与者（平均[标准差]年龄，73.6[2.9]岁；47.9%为男性；58.6%为白人；41.4%为黑人），并评估了HF的发病率、HF独立危险因素的人群归因风险（PAR）以及新发HF的结局。
结果
在中位随访7.1年期间，258名参与者（8.8%）发生了HF（每1000人年13.6例；95%置信区间，12.1 - 15.4）。男性和黑人参与者发生HF的可能性更高。在危险因素方面未观察到显著的性别差异。冠心病（白人参与者PAR为23.9%，黑人参与者为29.5%）和血压控制不佳（白人参与者PAR为21.3%，黑人参与者为30.1%）在两个种族中均具有最高的PAR。在黑人参与者中，评估的8个危险因素中有6个（吸烟、心率加快、冠心病、左心室肥厚、血压控制不佳和肾小球滤过率降低）的PAR比白人参与者高5%以上，导致黑人参与者中可改变危险因素导致的HF总体比例高于白人参与者（67.8%对48.9%）。发生HF的参与者年死亡率更高（18.0%对2.7%）。HF后生存率未观察到种族差异；然而，黑人参与者的再住院率更高（每100人年62.1次对30.3次住院，P <.001）。
结论
新发HF在老年人中很常见；很大一部分HF风险归因于可改变的危险因素。在预防和治疗工作中需要考虑HF危险因素和HF后住院率的种族差异。
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