Ren Qing-Wen, Katherine Teng Tiew-Hwa, Tse Yi-Kei, Tay Wan Ting, Li Hang-Long, Tromp Jasper, Yu Si-Yeung, Hung Denise, Wu Mei-Zhen, Chen Christopher, Yuk Yuen Jacqueline Kwan, Huang Jia-Yi, Ouwerkerk Wouter, Li Xin-Li, Teramoto Kanako, Chandramouli Chanchal, Tse Hung-Fat, Lam Carolyn S P, Yiu Kai-Hang
Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China.
Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
JACC Asia. 2023 Jan 3;3(1):108-119. doi: 10.1016/j.jacasi.2022.09.016. eCollection 2023 Feb.
Heart failure (HF) may increase the risk of dementia via shared risk factors.
The authors investigated the incidence, types, clinical correlates, and prognostic impact of dementia in a population-based cohort of patients with index HF.
The previously territory-wide database was interrogated to identify eligible patients with HF (N = 202,121) from 1995 to 2018. Clinical correlates of incident dementia and their associations with all-cause mortality were assessed using multivariable Cox/competing risk regression models where appropriate.
Among a total cohort aged ≥18 years with HF (mean age 75.3 ± 13.0 years, 51.3% women, median follow-up 4.1 [IQR: 1.2-10.2] years), new-onset dementia occurred in 22,145 (11.0%), with age-standardized incidence rate of 1,297 (95% CI: 1,276-1,318) per 10,000 in women and 744 (723-765) per 10,000 in men. Types of dementia were Alzheimer's disease (26.8%), vascular dementia (18.1%), and unspecified dementia (55.1%). Independent predictors of dementia included: older age (≥75 years, subdistribution hazard ratio [SHR]: 2.22), female sex (SHR: 1.31), Parkinson's disease (SHR: 1.28), peripheral vascular disease (SHR: 1.46), stroke (SHR: 1.24), anemia (SHR: 1.11), and hypertension (SHR: 1.21). The population attributable risk was highest for age ≥75 years (17.4%) and female sex (10.2%). New-onset dementia was independently associated with increased risk of all-cause mortality (adjusted SHR: 4.51; < 0.001).
New-onset dementia affected more than 1 in 10 patients with index HF over the follow-up, and portended a worse prognosis in these patients. Older women were at highest risk and should be targeted for screening and preventive strategies.
心力衰竭（HF）可能通过共同的危险因素增加患痴呆症的风险。
作者调查了以首次发生HF的患者为基础的队列人群中痴呆症的发病率、类型、临床相关性及预后影响。
查询先前覆盖全地区的数据库，以确定1995年至2018年期间符合条件的HF患者（N = 202,121）。在适当情况下，使用多变量Cox/竞争风险回归模型评估新发痴呆症的临床相关性及其与全因死亡率的关联。
在年龄≥18岁的HF总队列中（平均年龄75.3±13.0岁，女性占51.3%，中位随访时间4.1[四分位间距：1.2 - 10.2]年），22,145例（11.0%）发生了新发痴呆症，年龄标准化发病率在女性中为每10,000人1,297例（95%CI：1,276 - 1,318），在男性中为每10,000人744例（723 - 765）。痴呆症类型包括阿尔茨海默病（26.8%）、血管性痴呆（18.1%）和未明确类型的痴呆（55.1%）。痴呆症的独立预测因素包括：年龄较大（≥75岁，亚分布风险比[SHR]：2.22）、女性（SHR：1.31）、帕金森病（SHR：1.28）、外周血管疾病（SHR：1.46）、中风（SHR：1.24）、贫血（SHR：1.11）和高血压（SHR：1.21）。年龄≥75岁（17.4%）和女性（10.2%）的人群归因风险最高。新发痴呆症与全因死亡率增加独立相关（调整后的SHR：4.51；P < 0.001）。
在随访期间，超过十分之一的首次发生HF的患者出现了新发痴呆症，且这些患者预后较差。老年女性风险最高，应作为筛查和预防策略的目标人群。
