老年高血压患者心房颤动存在与否相关的性别差异。
Gender differences related to the presence of atrial fibrillation in older hypertensive patients.
作者信息
Fácila Lorenzo, Pallarés Vicente, Morillas Pedro, Cordero Alberto, Llisterri Jose Luis, Sánchis Carlos, Gorriz Jose L, Castillo Jesus, Gil Vicente, Redon Josep
机构信息
Lorenzo Fácila, Servicio de Cardiologia, Consorcio Hospitalario General de Valencia, 46014 Valencia, Spain.
出版信息
World J Cardiol. 2013 May 26;5(5):124-31. doi: 10.4330/wjc.v5.i5.124.
AIM
To determine whether there are gender differences in the epidemiological profile of atrial fibrillation (AF) and to characterise the clinical, biochemical, and therapeutic factors associated with AF.
METHODS
Each investigator (primary care physicians or physicians based in hospital units for hypertension treatment) recruited the first 3 patients with an age of ≥ 65 years and a clinical diagnosis of hypertension (ambulatory blood pressure monitoring and an electrocardiogram, were performed) on the first working day of the week for 5 wk and identified those individuals with atrial fibrillation. A binary logistic regression was performed, including all of the variables that were significant in the univariate analysis, to establish the variables that were associated with the presence of arrhythmia.
RESULTS
A total of 1028 patients were included in the study, with a mean age of 72.8 ± 5.8 years. Of these patients, 47.3% were male, 9% were smokers, 27.6% were diabetics, 48.3% had dyslipidaemia, 10.9% had angina, and 6.5% had experienced a myocardial infarction. Regarding gender differences, the men exhibited a larger waist circumference, a lower body mass index, less obesity, and a more extensive history of diabetes, smoking, ischaemic heart disease, kidney failure, peripheral arterial disease and carotid disease than the women. There were no differences, however, in the prevalence of AF between the men and the women (11.5% vs 9.2%, respectively; P = no significant). Regarding treatment, the women received antiplatelet agents and diuretics less frequently, but there were no other differences in the use of antihypertensive and antithrombotic therapies. In the multivariate analysis, AF in the total study population was associated with age, alcohol consumption, the presence of heart disease, and decreased glomerular filtration. In the women, AF was associated with all of the factors included in the overall analysis, as well as the presence of left ventricle hypertrophy. In contrast, in the men, the only risk factors associated with AF were age, the presence of heart disease and alcohol consumption.
CONCLUSION
In patients with hypertension over 65 years of age, there are relevant gender differences in the factors associated with AF.
目的
确定心房颤动（AF）的流行病学特征是否存在性别差异，并描述与AF相关的临床、生化和治疗因素。
方法
每位研究者（基层医疗医生或医院高血压治疗科室的医生）在每周的第一个工作日招募前3名年龄≥65岁且临床诊断为高血压（进行了动态血压监测和心电图检查）的患者，持续5周，并识别出心房颤动患者。进行二元逻辑回归分析，纳入单因素分析中所有具有统计学意义的变量，以确定与心律失常存在相关的变量。
结果
本研究共纳入1028例患者，平均年龄为72.8±5.8岁。其中，47.3%为男性，9%为吸烟者，27.6%为糖尿病患者，48.3%患有血脂异常，10.9%患有心绞痛，6.5%曾发生心肌梗死。关于性别差异，男性的腰围更大、体重指数更低、肥胖程度更低，且糖尿病、吸烟、缺血性心脏病、肾衰竭、外周动脉疾病和颈动脉疾病的病史比女性更广泛。然而，男性和女性的AF患病率无差异（分别为11.5%和9.2%；P无统计学意义）。在治疗方面，女性使用抗血小板药物和利尿剂的频率较低，但在抗高血压和抗血栓治疗的使用上没有其他差异。多因素分析显示，整个研究人群中的AF与年龄、饮酒、心脏病的存在以及肾小球滤过率降低有关。在女性中，AF与总体分析中包括的所有因素以及左心室肥厚的存在有关。相比之下，在男性中，与AF相关的唯一危险因素是年龄、心脏病的存在和饮酒。
结论
在65岁以上的高血压患者中，与AF相关的因素存在显著的性别差异。
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