Department of Cardiology, Herlev Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
Department of Cardiology, Herlev Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Department of Cardiovascular Epidemiology and Research, The Danish Heart Foundation, Copenhagen, Denmark.
Eur J Intern Med. 2019 May;63:56-61. doi: 10.1016/j.ejim.2019.02.014. Epub 2019 Mar 1.
The optimal medical treatment in patients with chronic obstructive pulmonary disease (COPD) and right-sided heart failure (RHF) is unknown. We aimed to estimate the risks of all-cause mortality associated with the current clinical use of various cardiovascular drugs in this patient-group.
We followed all patients with registered COPD and RHF (defined as a diagnosis of pulmonary hypertension plus use of loop-diuretics) for the risk of all-cause mortality (Jan 1, 1995 to Dec 31, 2015) using the Danish nationwide administrative registries. The association between mortality and claimed prescriptions for cardiovascular drugs was assessed by multivariable Cox regression models.
5991 patients (mean age 74 ± standard deviation 10 years, 51% women) were included. Of these, 1440 (24%) used beta-blockers, 2149 (36%) renin-angiotensin system inhibitors [RASi], 1340 (22%) oral anticoagulants, 1376 (23%) calcium channel blockers, 1194 (20%) statins, 1824 (30%) spironolactone, and 2099 (35%) low-dose aspirin. During an average follow-up of 2.2 years (±standard deviation 2.8, min-max 0-19.6 years), 5071 (85%) died, corresponding to a mortality rate of 38 per 100 person-years (95% confidence interval 37-39). Compared to no use, beta-blockers were associated with adjusted hazards ratio 0.90 (95% confidence interval 0.84-0.98), RASi 0.92 (0.86-0.98), calcium channel blockers 0.86 (0.80-0.92), spironolactone 1.17 (1.10-1.24), statins 0.85 (0.78-0.92), oral anticoagulants 0.87 (0.79-0.95), and aspirin 0.99 (0.93-1.05). Propensity-score matched analyses and inverse-probability-weighted models yielded similar results.
Several cardiovascular drugs may be associated with lowered mortality in COPD and RHF. Given the grave prognosis, randomized clinical trials are warranted to test this hypothesis.
慢性阻塞性肺疾病（COPD）和右侧心力衰竭（RHF）患者的最佳治疗方法尚不清楚。我们旨在评估当前在该患者群体中使用各种心血管药物的全因死亡率相关风险。
我们通过丹麦全国性行政登记处，对所有患有 COPD 和 RHF 的患者（定义为肺动脉高压诊断加使用袢利尿剂）进行全因死亡率（1995 年 1 月 1 日至 2015 年 12 月 31 日）风险随访。通过多变量 Cox 回归模型评估死亡率与心血管药物处方之间的关联。
5991 例患者（平均年龄 74±10 岁，51%为女性）纳入研究。其中，1440 例（24%）使用β受体阻滞剂，2149 例（36%）使用肾素-血管紧张素系统抑制剂[RASi]，1340 例（22%）使用口服抗凝剂，1376 例（23%）使用钙通道阻滞剂，1194 例（20%）使用他汀类药物，1824 例（30%）使用螺内酯，2099 例（35%）使用低剂量阿司匹林。在平均 2.2 年（±标准差 2.8，最小-最大 0-19.6 年）的随访期间，5071 例（85%）死亡，死亡率为 38/100 人年（95%置信区间 37-39）。与未使用相比，β受体阻滞剂的调整后危害比为 0.90（95%置信区间 0.84-0.98），RASi 为 0.92（0.86-0.98），钙通道阻滞剂为 0.86（0.80-0.92），螺内酯为 1.17（1.10-1.24），他汀类药物为 0.85（0.78-0.92），口服抗凝剂为 0.87（0.79-0.95），阿司匹林为 0.99（0.93-1.05）。倾向评分匹配分析和逆概率加权模型得出了相似的结果。
几种心血管药物可能与 COPD 和 RHF 患者的死亡率降低相关。鉴于预后严重，需要进行随机临床试验来检验这一假设。
