Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia.
Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
Heart Lung Circ. 2020 Oct;29(10):1517-1526. doi: 10.1016/j.hlc.2020.03.002. Epub 2020 Mar 23.
The incidence of ischaemic heart disease (IHD) has fallen consistently in the general population; attributed to effective primary prevention strategies. Differences in incidence have been demonstrated by sex. Whether this fall in incidence and sex differences is mirrored in people with end-stage kidney disease (ESKD) is unclear. We aimed to establish the relative risk of IHD events in the ESKD population.
We performed a retrospective cohort study from 2000 to 2010 in people with ESKD in New South Wales. We performed data linkage of the Australia and New Zealand Dialysis and Transplant Registry and state wide hospital admission and death registry data and compared this to general population data. The primary outcome was the incidence rate, incidence rate ratio (IRR), and time-trend for any IHD event. We calculated these using indirect standardisation by IHD event.
10,766 participants, contributed 44,149 years of observation time. Incidence rates were substantially higher than the general population for all IHD events (any IHD event: IRR 1.8, 95% confidence interval [CI] 1.7-1.9 for men, IRR 3.4, 95% CI 3.1-3.6 for women). Excess risk was higher in younger people (age 30-49 IRR 4.8, 95% CI 4.2-5.4), and in women with a three-fold increase risk overall and nearly a 10-fold increase in risk in young women (female age 30-49 years: IRR 9.8 95% CI 7.7-12.3), results were similar for angina and acute myocardial infarction. Ischaemic heart disease rates showed some decline for men over time, (ratio of IRR 0.93, 95% CI 0.90-0.95) but were stable for women (ratio of IRR 0.97, 95% CI 0.94-1.01).
People with ESKD have substantially higher rates of IHD than the general population, especially women, in whom no improvement appears evident over the past 10 years.
缺血性心脏病（IHD）的发病率在普通人群中持续下降；归因于有效的初级预防策略。不同性别之间的发病率存在差异。在终末期肾病（ESKD）患者中，这种发病率的下降和性别差异是否得到体现尚不清楚。我们旨在确定 ESKD 人群中 IHD 事件的相对风险。
我们在 2000 年至 2010 年间对新南威尔士州的 ESKD 患者进行了回顾性队列研究。我们对澳大利亚和新西兰透析和移植登记处以及全州住院和死亡登记处的数据进行了数据链接，并将其与普通人群的数据进行了比较。主要结局是任何 IHD 事件的发生率、发病率比（IRR）和时间趋势。我们使用 IHD 事件的间接标准化来计算这些。
10766 名参与者，贡献了 44149 年的观察时间。与普通人群相比，所有 IHD 事件的发生率都明显较高（任何 IHD 事件：男性 IRR 为 1.8，95%置信区间[CI]为 1.7-1.9，女性 IRR 为 3.4，95%CI 为 3.1-3.6）。年轻人的风险更高（年龄 30-49 岁 IRR 为 4.8，95%CI 为 4.2-5.4），女性总体风险增加三倍，年轻女性风险增加近十倍（女性年龄 30-49 岁：IRR 9.8，95%CI 为 7.7-12.3），心绞痛和急性心肌梗死的结果相似。随着时间的推移，男性的 IHD 发病率有所下降（IRR 的比值为 0.93，95%CI 为 0.90-0.95），而女性则保持稳定（IRR 的比值为 0.97，95%CI 为 0.94-1.01）。
与普通人群相比，ESKD 患者的 IHD 发生率明显较高，尤其是女性，在过去 10 年中，女性的 IHD 发病率似乎没有明显改善。
