Apostolovic Svetlana, Stanojevic Dragana, Lainscak Mitja, Gelbrich Goetz, Jankovic-Tomasevic Ruzica, Pavlovic Milan, Djordjevic-Radojkovic Danijela, Salinger-Martinovic Sonja, Putnikovic Biljana, Radovanovic Slavica, Waagstein Finn, Tomasevic Miloje, Tahirovic Elvis, Inkrot Simone, Musial-Bright Lindy, Düngen Hans-Dirk
Clinic for cardiovascular diseases, Clinical Center Nis, Serbia.
Cardiol J. 2014;21(3):265-72. doi: 10.5603/CJ.a2013.0117. Epub 2013 Aug 30.
The aim of our study was to examine regional differences in the demographics, etiology, risk factors, comorbidities and treatment of female patients with heart failure (HF) in the Cardiac Insufficiency BIsoprolol Study in ELDerly (CIBIS-ELD) clinical trial.
One hundred and fifty-nine female patients from Germany and 169 from Southeastern (SE) Europe (Serbia, Slovenia and Montenegro) were included in this subanalysis of the CIBIS-ELD trial. Women comprised 54% of the study population in Germany and 29% in SE Europe. German patients were significantly older. The leading cause of HF was arterial hypertension in German patients, 71.7% of whom had a preserved ejection fraction. The leading etiology in SE Europe was the coronary artery disease; 67.6% of these patients had a reduced left ventricular ejection fraction (34.64 ± 7.75%). No significant differences were found in the prevalence of traditional cardiovascular risk factors between the two regions (hypertension, diabetes, hypercholesterolemia, smoking and family history of myocardial infarction). Depression, chronic obstructive pulmonary disease and malignancies were the comorbidities that were noted more frequently in the German patients, while the patients from SE Europe had a lower glomerular filtration rate. Compared with the German HF patients, the females in SE Europe received significantly more angiotensin converting enzyme inhibitors, loop diuretics and less frequently angiotensin receptor blockers and mineralocorticoid receptor antagonists.
Significant regional differences were noted in the etiology, comorbidities and treatment of female patients with HF despite similar risk factors. Such differences should be considered in the design and implementation of future clinical trials, especially as women remain underrepresented in large trial populations.
我们研究的目的是在老年人心力衰竭比索洛尔研究（CIBIS-ELD）临床试验中，考察女性心力衰竭（HF）患者在人口统计学、病因、危险因素、合并症及治疗方面的地区差异。
本CIBIS-ELD试验的亚分析纳入了159名来自德国的女性患者和169名来自东南欧（塞尔维亚、斯洛文尼亚和黑山）的女性患者。在德国，女性占研究人群的54%，在东南欧占29%。德国患者年龄显著更大。德国患者HF的主要病因是动脉高血压，其中71.7%的患者射血分数保留。东南欧的主要病因是冠状动脉疾病；这些患者中有67.6%的左心室射血分数降低（34.64±7.75%）。两个地区在传统心血管危险因素（高血压、糖尿病、高胆固醇血症、吸烟和心肌梗死家族史）的患病率方面未发现显著差异。抑郁症、慢性阻塞性肺疾病和恶性肿瘤在德国患者中更常被记录为合并症，而东南欧的患者肾小球滤过率较低。与德国HF患者相比，东南欧的女性接受血管紧张素转换酶抑制剂和襻利尿剂的比例显著更高，接受血管紧张素受体阻滞剂和盐皮质激素受体拮抗剂的比例更低。
尽管危险因素相似，但女性HF患者在病因、合并症及治疗方面存在显著的地区差异。在未来临床试验的设计和实施中应考虑到这些差异，尤其是鉴于在大型试验人群中女性的代表性仍然不足。
