抗痴呆药物治疗患者心血管事件的危险因素
Risk Factors for Cardiovascular Events in Patients on Antidementia Medications.
作者信息
He Meiqi, Stevenson James M, Zhang Yuting, Hernandez Inmaculada
机构信息
Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA.
Division of Clinical Pharmacology, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
出版信息
Am J Alzheimers Dis Other Demen. 2020 Jan-Dec;35:1533317520922380. doi: 10.1177/1533317520922380.
OBJECTIVE
To identify characteristics associated with an increased risk of cardiovascular events in patients diagnosed with Alzheimer disease (AD) and treated with antidementia medications.
METHODS
Demographics, diagnoses, and medication usage of 30 433 Medicare patients were analyzed using 2006 to 2013 claims data and a combined model of screening, ranking and stepwise logistic regressions to evaluate factors associated with composite outcomes of 6 cardiovascular events.
RESULTS
Incidence rate of at least 1 cardiovascular event was 25.1%. Fifty-five factors were identified from the 10 381 candidate variables by the combined model with a c-statistic of 67% and an accuracy of 75%. Factors associated with increased risk of cardiovascular events include history of heart rhythm disorders, alteration of consciousness (odds ratio [OR]: 1.25; 95% confidence interval [CI]: 1.14-1.36), and usage of β-blockers (OR: 1.19; 95% CI: 1.13-1.27).
CONCLUSIONS
Clinicians should consider the increased risk of cardiovascular events in patients with AD with heart rhythm disorders and on β-blockers.
目的
确定被诊断为阿尔茨海默病（AD）并接受抗痴呆药物治疗的患者发生心血管事件风险增加的相关特征。
方法
利用2006年至2013年的索赔数据以及筛查、排序和逐步逻辑回归的组合模型，分析30433名医疗保险患者的人口统计学、诊断和用药情况，以评估与6种心血管事件复合结局相关的因素。
结果
至少发生1次心血管事件的发生率为25.1%。通过组合模型从10381个候选变量中识别出55个因素，c统计量为67%，准确率为75%。与心血管事件风险增加相关的因素包括心律紊乱病史、意识改变（比值比[OR]：1.25；95%置信区间[CI]：1.14 - 1.36）以及β受体阻滞剂的使用（OR：1.19；95%CI：1.13 - 1.27）。
结论
临床医生应考虑患有心律紊乱且使用β受体阻滞剂的AD患者发生心血管事件的风险增加。
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