二十年来青年人群因急性心肌梗死住院的趋势及性别差异。
Twenty Year Trends and Sex Differences in Young Adults Hospitalized With Acute Myocardial Infarction.
机构信息
Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill (S.A., G.S., M.C.).
Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill (S.A., A.KN, W.R.).
出版信息
Circulation. 2019 Feb 19;139(8):1047-1056. doi: 10.1161/CIRCULATIONAHA.118.037137.
BACKGROUND
Sex differences are known to exist in the management of older patients presenting with acute myocardial infarction (AMI). Few studies have examined the incidence and risk factors of AMI among young patients, or whether clinical management differs by sex.
METHODS
The Atherosclerosis Risk in Communities (ARIC) Surveillance study conducts hospital surveillance of AMI in 4 US communities (MD, MN, MS, and NC). AMI was classified by physician review, using a validated algorithm. Medications and procedures were abstracted from the medical record. Our study population was limited to young patients aged 35 to 54 years.
RESULTS
From 1995 to 2014, 28 732 weighted hospitalizations for AMI were sampled among patients aged 35 to 74 years. Of these, 8737 (30%) were young. The annual incidence of AMI hospitalizations increased for young women but decreased for young men. The overall proportion of AMI admissions attributable to young patients steadily increased, from 27% in 1995 to 1999 to 32% in 2010 to 2014 ( P for trend=0.002), with the largest increase observed in young women. History of hypertension (59% to 73%, P for trend<0.0001) and diabetes mellitus (25% to 35%, P for trend<0.0001) also increased among young AMI patients. Compared to young men, young women presenting with AMI were more often black and had a greater comorbidity burden. In adjusted analyses, young women had a lower probability of receiving lipid-lowering therapies (relative risk [RR]=0.87; 95% confidence interval [CI], 0.80-0.94), nonaspirin antiplatelets (RR=0.83; 95% CI, 0.75-0.91), beta blockers (RR=0.96; 95% CI, 0.91-0.99), coronary angiography (RR=0.93; 95% CI, 0.86-0.99) and coronary revascularization (RR = 0.79; 95% CI, 0.71-0.87). However, 1-year all-cause mortality was comparable for women versus men (HR=1.10; 95% CI, 0.83-1.45).
CONCLUSIONS
The proportion of AMI hospitalizations attributable to young patients increased from 1995 to 2014 and was especially pronounced among women. History of hypertension and diabetes among young patients admitted with AMI increased over time as well. Compared with young men, young women presenting with AMI had a lower likelihood of receiving guideline-based AMI therapies. A better understanding of factors underlying these changes is needed to improve care of young patients with AMI.
背景
已知在治疗老年急性心肌梗死（AMI）患者时存在性别差异。很少有研究检查年轻患者中 AMI 的发生率和危险因素，也没有研究是否存在性别差异。
方法
Atherosclerosis Risk in Communities（ARIC）监测研究对美国 4 个社区（MD、MN、MS 和 NC）的 AMI 进行医院监测。AMI 通过医生审查进行分类，使用经过验证的算法。药物和程序从病历中提取。我们的研究人群仅限于年龄在 35 至 54 岁的年轻患者。
结果
1995 年至 2014 年，对年龄在 35 至 74 岁的患者进行了 28732 例 AMI 加权住院治疗抽样。其中 8737 例（30%）为年轻患者。年轻女性的 AMI 住院率逐年上升，而年轻男性的住院率则下降。归因于年轻患者的 AMI 入院比例总体呈稳步上升趋势，从 1995 年至 1999 年的 27%上升到 2010 年至 2014 年的 32%（趋势 P=0.002），其中年轻女性的增幅最大。年轻 AMI 患者中高血压（59%至 73%，趋势 P<0.0001）和糖尿病（25%至 35%，趋势 P<0.0001）的比例也有所增加。与年轻男性相比，年轻女性因 AMI 就诊时黑人更多，合并症负担更重。在调整分析中，年轻女性接受降脂治疗（相对风险[RR]=0.87；95%置信区间[CI]，0.80-0.94）、非阿司匹林抗血小板药物（RR=0.83；95% CI，0.75-0.91）、β受体阻滞剂（RR=0.96；95% CI，0.91-0.99）、冠状动脉造影（RR=0.93；95% CI，0.86-0.99）和冠状动脉血运重建（RR=0.79；95% CI，0.71-0.87）的可能性较低。然而，女性与男性的 1 年全因死亡率相当（HR=1.10；95% CI，0.83-1.45）。
结论
1995 年至 2014 年，归因于年轻患者的 AMI 住院比例增加，在女性中尤为明显。此外，年轻患者中 AMI 的高血压和糖尿病病史也随着时间的推移而增加。与年轻男性相比，年轻女性因 AMI 就诊时接受指南推荐的 AMI 治疗的可能性较低。需要更好地了解这些变化背后的因素，以改善年轻 AMI 患者的治疗。
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