Kamil Sadaf, Sehested Thomas S G, Houlind Kim, Lassen Jens F, Gislason Gunnar H, Dominguez Helena
Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Kildegaardsvej 28, 2900 Hellerup, Denmark.
Department of Cardiology, Bispebjerg-Frederiksberg University Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark.
Eur Heart J Qual Care Clin Outcomes. 2023 Feb 28;9(2):142-149. doi: 10.1093/ehjqcco/qcac022.
Over the past decades, there have been improvements in the management of cardiovascular (CV) disease and risk factors. Long-term contemporary data on the population-level incidence of myocardial infarction (MI), heart failure (HF), and CV mortality in patients with peripheral artery disease (PAD) are sparse, which we aim to investigate in this study.
Danish nationwide registers were used to identify all patients aged ≥18 years, with first diagnosis of PAD between 1997 and 2016. Age-standardized incidence rates (IRs) per 1000 person-years were calculated to estimate trends of MI, HF, and CV mortality. The risk of MI, HF, and CV mortality was estimated by 1-year cumulative incidence with death as the competing risk. A total of 131 568 patients with PAD were identified [median age 70.67 (interquartile range, IQR, 61-78) years and 53.05% males]. The IRs showed increasing trends of MI until 2002, with an estimated annual percentage change (APC) of + 0.6 [95% confidence interval (CI) 3.3-16.1, P-value 0.2]. After the year 2002, MI incidence persistently decreased until the study end with an estimated APC of -5.0 (95% CI 3.7-6.3, P < 0.0001), HF declined with an estimated APC of -3.3 (95% CI 2.0-4.6, P < 0.0001); and CV mortality declined, with an APC of -3.5 (95% CI 3.0-4.0, P < 0.0001).
The incidence of MI (since 2002) and HF in patients with PAD has significantly decreased over time, together with a decline in CV mortality. Our results suggest that preventive strategies have overall improved, most likely due to improvements in the application of guidelines in clinical care.
在过去几十年中，心血管疾病（CV）及其危险因素的管理已有改善。关于外周动脉疾病（PAD）患者中心肌梗死（MI）、心力衰竭（HF）的人群水平发病率以及CV死亡率的长期当代数据较为匮乏，本研究旨在对此进行调查。
利用丹麦全国登记系统识别出所有年龄≥18岁、于1997年至2016年间首次诊断为PAD的患者。计算每1000人年的年龄标准化发病率（IRs）以估计MI、HF和CV死亡率的趋势。以死亡作为竞争风险，通过1年累积发病率估计MI、HF和CV死亡的风险。共识别出131568例PAD患者[中位年龄70.67（四分位间距，IQR，61 - 78）岁，男性占53.05%]。IRs显示MI发病率在2002年前呈上升趋势，估计年度百分比变化（APC）为 +0.6[95%置信区间（CI）3.3 - 16.1，P值0.2]。2002年后，MI发病率持续下降直至研究结束，估计APC为 -5.0（95% CI 3.7 - 6.3，P < 0.0001），HF下降，估计APC为 -3.3（95% CI 2.0 - 4.6，P < 0.0001）；CV死亡率下降，APC为 -3.5（95% CI 3.0 - 4.0，P < 0.0001）。
随着时间推移，PAD患者中MI（自2002年起）和HF的发病率显著下降，同时CV死亡率也有所下降。我们的结果表明预防策略总体上有所改善，很可能是由于临床护理中指南应用的改进。
