Agarwal Shikhar, Sud Karan, Thakkar Badal, Menon Venu, Jaber Wael A, Kapadia Samir R
Department of Cardiovascular Medicine, Geisinger Medical Center, Danville, Pennsylvania.
Department of Internal Medicine, Mount Sinai St Luke's Hospital, New York, New York.
Am J Cardiol. 2017 May 15;119(10):1532-1541. doi: 10.1016/j.amjcard.2017.02.027. Epub 2017 Mar 31.
We aimed to evaluate the secular trends in demographics, risk factors, and clinical characteristics of patients presenting with acute myocardial infarction (AMI) or acute ischemic stroke (AIS), using a large nationally representative data set of in-hospital admissions. We used the 2003 to 2013 Nationwide Inpatient Sample. All admissions with primary diagnosis of AMI or AIS were included. Across 2003 to 2013, a total of 1,360,660 patients with AMI and 937,425 patients with AIS were included in the study. We noted a progressive reduction in the mean age of patients presenting with AMI and AIS (p trend <0.001 for all groups), implying that the burden of young patients with these acute syndromes is progressively increasing. In addition, there was a progressive increase in the proportion of patients who are uninsured among patients presenting with AMI and AIS. Furthermore, despite a progressively younger age at presentation, there was an observed increase in the prevalence of atherosclerotic risk factors including hypertension, hyperlipidemia, diabetes, smoking, and obesity among patients presenting with AMI or AIS during 2003 to 2013. Significant disparities were noted in the prevalence of risk factors among various demographic and geographical cohorts. Low socioeconomic status as well as uninsured patients had a significantly higher prevalence of preventable risk factors like smoking and obesity as compared to the high socioeconomic status and insured patients, respectively. In conclusion, there have been significant changes in the risk factor profile of patients presenting with AMI and AIS over the last decade.
我们旨在利用一个具有全国代表性的大型住院患者数据集，评估急性心肌梗死（AMI）或急性缺血性卒中（AIS）患者在人口统计学、风险因素和临床特征方面的长期趋势。我们使用了2003年至2013年的全国住院患者样本。纳入所有以AMI或AIS为主要诊断的住院病例。在2003年至2013年期间，共有1360660例AMI患者和937425例AIS患者纳入本研究。我们注意到，AMI和AIS患者的平均年龄逐渐降低（所有组的p趋势<0.001），这意味着患有这些急性综合征的年轻患者负担在逐渐增加。此外，AMI和AIS患者中未参保患者的比例逐渐上升。此外，尽管发病年龄逐渐年轻化，但在2003年至2013年期间，AMI或AIS患者中包括高血压、高脂血症、糖尿病、吸烟和肥胖在内的动脉粥样硬化风险因素的患病率有所上升。在不同人口统计学和地理队列的风险因素患病率方面存在显著差异。与高社会经济地位和参保患者相比，低社会经济地位以及未参保患者的吸烟和肥胖等可预防风险因素的患病率显著更高。总之，在过去十年中，AMI和AIS患者的风险因素状况发生了显著变化。
