Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK.
Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand.
J Clin Endocrinol Metab. 2021 Apr 23;106(5):1284-1293. doi: 10.1210/clinem/dgab063.
Mortality studies have established that cardiovascular disease is the leading cause of death in patients with adrenal insufficiency and the risk is greater than that observed in individually matched controls.
Here we have performed a detailed analysis of cardiovascular morbidity and mortality, taking account of the role of comorbidities.
We performed a retrospective cohort study using the Clinical Practice Research Datalink (CPRD), a UK general practitioner database. The participant population comprised 6821 patients with adrenal insufficiency (primary, 2052; secondary, 3948) compared with 67 564 individually matched controls, with and without adjustment for comorbidities (diabetes, hypertension, dyslipidemia, previous cardiovascular disease, and smoking). The main outcome measures were composite cardiovascular events recorded in the CPRD and cardiovascular mortality in participants with linked national mortality data.
Hazard ratios (95% CI) for composite cardiovascular events in patients with adrenal insufficiency of any cause were 1.28 (1.20-1.36, unadjusted) and 1.07 (1.01-1.14, adjusted). Increased cerebrovascular events in patients with secondary adrenal insufficiency accounted for most of the increased hazard (1.53 [1.34-1.74, adjusted]) and were associated with cranial irradiation therapy. Cardiovascular mortality data were available for 3547 patients and 34 944 controls. The adjusted hazard ratio for ischemic heart disease mortality was 1.86 (1.25-2.78) for primary adrenal insufficiency and 1.39 (1.02-1.89) for secondary.
Comorbidities largely accounted for the increased cardiovascular events but in secondary adrenal insufficiency, cerebrovascular events were independently increased and associated with irradiation treatment. However, the risk of cardiovascular mortality remained increased even following adjustment for comorbidities in both primary and secondary adrenal insufficiency.
死亡率研究已经证实，心血管疾病是肾上腺功能不全患者的主要死亡原因，其风险高于单独匹配对照患者。
在此，我们详细分析了心血管发病率和死亡率，考虑了合并症的作用。
我们使用英国全科医生数据库临床实践研究数据链（CPRD）进行了回顾性队列研究。研究人群包括 6821 例肾上腺功能不全患者（原发性，2052 例；继发性，3948 例），并与 67564 例单独匹配的对照患者进行了比较，对合并症（糖尿病、高血压、血脂异常、既往心血管疾病和吸烟）进行了调整和未调整。主要观察指标为 CPRD 记录的复合心血管事件和具有国家死亡数据链接的参与者的心血管死亡率。
任何原因引起的肾上腺功能不全患者的复合心血管事件的危险比（95%可信区间）分别为 1.28（1.20-1.36，未调整）和 1.07（1.01-1.14，调整）。继发性肾上腺功能不全患者的脑血管事件增加是导致危险增加的主要原因（1.53 [1.34-1.74，调整]），与颅照射治疗有关。有 3547 例患者和 34944 例对照患者可获得心血管死亡率数据。原发性肾上腺功能不全的缺血性心脏病死亡率的调整危险比为 1.86（1.25-2.78），继发性肾上腺功能不全为 1.39（1.02-1.89）。
合并症在很大程度上解释了心血管事件的增加，但在继发性肾上腺功能不全中，脑血管事件独立增加，并与照射治疗有关。然而，即使在原发性和继发性肾上腺功能不全中，对合并症进行调整后，心血管死亡率的风险仍然增加。
