Wang Elizabeth Y, Dixson Jeffrey, Schiller Nelson B, Whooley Mary A
Department of Medicine, University of California, San Francisco, California.
Department of Internal Medicine, Yale University, New Haven, Connecticut.
Am J Cardiol. 2017 Jan 1;119(1):27-34. doi: 10.1016/j.amjcard.2016.09.006. Epub 2016 Sep 29.
Although the prevalence of coronary heart disease (CHD) in the United States has increased during the past 25 years, cardiovascular mortality has decreased due to advances in CHD therapy and prevention. We sought to determine the proportion of patients with CHD who die from cardiovascular versus noncardiovascular causes and the causes and predictors of death, in a cohort of patients with CHD. The Heart and Soul Study enrolled 1,024 participants with stable CHD from 2000 to 2002 and followed them for 10 years. Causes of mortality were assigned based on detailed review of medical records, death certificates, and coroner reports by blinded adjudicators. During 7,680 person-years of follow-up, 401 participants died. Of these deaths, 42.4% were cardiovascular and 54.4% were noncardiovascular. Myocardial infarction, stroke, and sudden death accounted for 72% of cardiovascular deaths. Cancer, pneumonia, and sepsis accounted for 67% of noncardiovascular deaths. Independent predictors of cardiac mortality were older age, inducible ischemia on stress echocardiography, higher heart rate at rest, smoking, lower hemoglobin, and higher N-terminal pro-brain natriuretic peptide (all p values <0.05); independent predictors of noncardiac mortality included older age, inducible ischemia, higher heart rate, lower exercise capacity, and nonuse of statins (all p values <0.05). In conclusion, mortality in this cohort was more frequently due to noncardiovascular causes, and predictors of noncardiovascular mortality included factors traditionally associated with cardiovascular mortality.
尽管在过去25年中，美国冠心病（CHD）的患病率有所上升，但由于冠心病治疗和预防方面的进展，心血管疾病死亡率有所下降。我们试图确定冠心病患者死于心血管疾病与非心血管疾病原因的比例，以及死亡原因和预测因素，研究对象为一组冠心病患者。“心灵研究”在2000年至2002年招募了1024名稳定型冠心病参与者，并对他们进行了10年的随访。死亡原因由盲法判定者根据对医疗记录、死亡证明和验尸官报告的详细审查来确定。在7680人年的随访期间，401名参与者死亡。在这些死亡病例中，42.4%为心血管疾病死亡，54.4%为非心血管疾病死亡。心肌梗死、中风和猝死占心血管疾病死亡的72%。癌症、肺炎和败血症占非心血管疾病死亡的67%。心脏死亡的独立预测因素包括年龄较大、负荷超声心动图显示可诱导性缺血、静息心率较高、吸烟、血红蛋白水平较低以及N末端脑钠肽前体水平较高（所有p值<0.05）；非心脏死亡的独立预测因素包括年龄较大、可诱导性缺血、心率较高、运动能力较低以及未使用他汀类药物（所有p值<0.05）。总之，该队列中的死亡更常见于非心血管疾病原因，非心血管疾病死亡的预测因素包括传统上与心血管疾病死亡相关的因素。
