Centre for Family Medicine, Karolinska Institutet, Alfred Nobels Allé 12, 141 83 Huddinge, Sweden.
Eur J Clin Pharmacol. 2013 Feb;69(2):279-87. doi: 10.1007/s00228-012-1395-2. Epub 2012 Sep 19.
Risk factors for stroke are well known in atrial fibrillation (AF) patients, while less is known on the effect of these factors on total mortality.
Our aim was to study the impact of cardiovascular drug classes on mortality in AF patients treated in primary care.
The study population was chosen based on patient data from 75 primary care centres in Sweden compiled in a database. Individuals diagnosed with AF who were older than 45 years were enrolled (n = 12,302, of whom 6,660 were men). Cox regression analysis with mortality (years to death) as outcome was conducted in the men and women separately, as well in the age categories <80 and ≥ 80 years, with cardiovascular drugs as independent factors, and age, cardiovascular diagnoses and educational level as covariates.
Lower mortality was shown for anticoagulant treatment among men, both younger (<80 years) [adjusted hazard ratio (HR) 0.43, 95 % confidence interval (CI) 0.31-0.61] and older (≥ 80 years) (adjusted HR 0.47, 95 % CI 0.32-0.69), and among younger women (adjusted HR 0.46, 95 % CI 0.29-0.74), and for antiplatelet treatment in older men (adjusted HR 0.51, 95 % CI 0.35-0.74). Treatment with thiazides was associated with lower mortality among younger men (adjusted HR 0.68, 95 % CI 0.48-0.96), older men (adjusted HR 0.67, 95 % CI 0.46-0.98) and older women (adjusted HR 0.70, 95 % CI 0.52-0.94). Statins were associated with lower mortality among younger patients, in both men (adjusted HR 0.47, 95 % CI 0.32-0.68) and women (adjusted HR 0.54, 95 % CI 0.35-0.82).
The differences in age and gender patterns need further exploration.
在心房颤动（AF）患者中，中风的风险因素众所周知，而这些因素对总死亡率的影响则知之甚少。
我们旨在研究心血管药物类别对初级保健中 AF 患者死亡率的影响。
该研究人群是根据瑞典 75 个初级保健中心的患者数据从数据库中选择的。招募年龄大于 45 岁且被诊断为 AF 的个体（n=12302，其中 6660 人为男性）。对男性和女性分别进行 Cox 回归分析，以死亡率（死亡年数）为结果，年龄<80 岁和≥80 岁两个年龄组，心血管药物为独立因素，年龄、心血管诊断和教育水平为协变量。
男性抗凝治疗的死亡率较低，年龄<80 岁（校正危险比[HR]0.43，95%置信区间[CI]0.31-0.61）和年龄≥80 岁（校正 HR 0.47，95%CI 0.32-0.69），年龄<80 岁的女性（校正 HR 0.46，95%CI 0.29-0.74），年龄≥80 岁的男性抗血小板治疗（校正 HR 0.51，95%CI 0.35-0.74）。噻嗪类药物治疗与年轻男性（校正 HR 0.68，95%CI 0.48-0.96）、老年男性（校正 HR 0.67，95%CI 0.46-0.98）和老年女性（校正 HR 0.70，95%CI 0.52-0.94）死亡率较低相关。他汀类药物与年轻患者（男性校正 HR 0.47，95%CI 0.32-0.68；女性校正 HR 0.54，95%CI 0.35-0.82）死亡率较低相关。
年龄和性别模式的差异需要进一步探讨。
