Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
TIMI Study Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Clin Cardiol. 2022 Aug;45(8):831-838. doi: 10.1002/clc.23843. Epub 2022 Jul 19.
Heart failure (HF) is a growing public health problem and ischemic heart disease is an important risk factor. Understanding the epidemiology of HF in patients with atherosclerosis may help identify subgroups at greater risk who have the potential to derive greater benefit from preventive strategies.
The TRA 2°P-TIMI 50 trial randomized 26,449 patients with stable atherosclerosis to the antiplatelet agent vorapaxar versus placebo. Hospitalization for HF (HHF) endpoints were adjudicated from serious adverse events by blinded structured review using established definitions. HHF incidence was estimated using Kaplan-Meier analysis. Independent predictors of HHF risk were identified using multivariable logistic regression. The effect of vorapaxar on HHF risk was explored using Cox regression. The estimated incidence of HHF at 3 years was 1.6%. Independent predictors of HHF included prior HF (adjusted odds ratio [adj-OR]: 8.31; 95% confidence interval [CI]: 6.56-10.54), age (adj-OR [per 10 years]: 1.67; 95% CI: 1.47-1.89), type 2 diabetes mellitus (T2DM; adj-OR: 2.55; 95% CI: 2.01-3.24), polyvascular disease (two-territory disease, adj-OR: 1.89; 95% CI: 1.46-2.44; three-territory disease, adj-OR: 2.68; 95% CI: 1.94-3.70), chronic kidney disease (CKD; adj-OR: 1.65; 95% CI: 1.30-2.11), body mass index (BMI; adj-OR [per 5 kg/m ]: 1.15; 95% CI: 1.03-1.27), prior myocardial infarction (MI) (adj-OR: 1.35; 95% CI: 1.03-1.78), and hypertension (adj-OR: 1.44; 95% CI: 1.02-2.04). Patients who experienced HHF during follow-up had higher rates of subsequent rehospitalization and death. Vorapaxar did not modify the risk of HHF.
In patients with stable atherosclerosis, prior HF, age, T2DM, polyvascular disease, CKD, BMI, prior MI, and hypertension are important predictors of HHF risk.
心力衰竭（HF）是一个日益严重的公共卫生问题，缺血性心脏病是一个重要的危险因素。了解动脉粥样硬化患者心力衰竭的流行病学情况，有助于识别风险更大的亚组，这些亚组有可能从预防策略中获益更多。
TRA 2°P-TIMI 50 试验将 26449 例稳定型动脉粥样硬化患者随机分配至抗血小板药物沃拉帕沙与安慰剂组。HF 住院（HHF）终点由盲法结构审查根据既定定义从严重不良事件中裁定。采用 Kaplan-Meier 分析估计 HHF 发生率。使用多变量逻辑回归确定 HHF 风险的独立预测因素。使用 Cox 回归探讨沃拉帕沙对 HHF 风险的影响。3 年时 HHF 的估计发生率为 1.6%。HHF 的独立预测因素包括既往 HF（校正优势比 [adj-OR]：8.31；95%置信区间 [CI]：6.56-10.54）、年龄（adj-OR[每 10 年]：1.67；95%CI：1.47-1.89）、2 型糖尿病（T2DM；adj-OR：2.55；95%CI：2.01-3.24）、多血管疾病（双血管疾病，adj-OR：1.89；95%CI：1.46-2.44；三血管疾病，adj-OR：2.68；95%CI：1.94-3.70）、慢性肾脏病（CKD；adj-OR：1.65；95%CI：1.30-2.11）、体重指数（BMI；adj-OR[每 5kg/m2]：1.15；95%CI：1.03-1.27）、既往心肌梗死（MI；adj-OR：1.35；95%CI：1.03-1.78）和高血压（adj-OR：1.44；95%CI：1.02-2.04）。随访期间发生 HHF 的患者有更高的再次住院和死亡风险。沃拉帕沙并未改变 HHF 的风险。
在稳定型动脉粥样硬化患者中，既往 HF、年龄、T2DM、多血管疾病、CKD、BMI、既往 MI 和高血压是 HHF 风险的重要预测因素。
