冠心病事件后二级预防随访中的性别差异。

Sex differences in secondary preventive follow-up after coronary heart events.

机构信息

Department of Research, Sørlandet Hospital, Kristiansand S, Norway.

Department of Endocrinology, Obesity and Preventive Medicine, Section of Preventive Cardiology, Oslo University Hospital, Oslo, Norway.

出版信息

BMC Cardiovasc Disord. 2023 Sep 14;23(1):459. doi: 10.1186/s12872-023-03483-6.

DOI:10.1186/s12872-023-03483-6

PMID:37710178

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10502978/

Abstract

BACKGROUND AND AIMS

Some studies point to sex differences in cardiovascular preventive practices. The aim of this study was to investigate differences in achievement of secondary preventive targets and long-term outcome in men and women after a coronary heart event.

METHODS

This study was a subanalysis from a randomized controlled trial of hospital-based versus primary care-based secondary preventive follow-up at Sorlandet Hospital, Norway, 2007-2022 and included both groups. The main outcome was achievement of treatment targets two years after the index event. Event-free survival was calculated based on the composite of mortality, coronary intervention, stroke, or myocardial infarction during follow-up. Participants were followed-up for up to 10 years after the index event through out-patient consultations.

RESULTS

In total, 337 women and 1203 men were eligible for the study. Due to loss of follow-up during the first two years after the index coronary event 106 (7%) participants were excluded from further analysis (53% withdrawal of consent, 12% death, and 35% other causes) leaving 307 (21%) women and 1127 (79%) men. After two years of follow-up we found no differences between women and men in achievement of blood pressure targets (61% vs. 59%; p = 0.57), LDL-cholesterol goals (64% vs. 69%; p = 0.15), HbA1c-goal in patients with diabetes (49% vs. 45%; p = 0.57), non-smoking (79% vs. 81%; p = 0.34), healthy diets (14% vs. 13%, p = 0.89), physical activity (55% vs. 58%; p = 0.38), use of acetylsalicylic acid (93% vs. 94%; p = 0.39), and use of lipid lowering therapy (92% vs. 94%; p = 0.15). After a median follow-up time of 5.0 [SD 3.2] years there were no differences between women and men regarding composite endpoint (89 [30.0%] vs. 345 [30.6]; p = 0.58), and composite endpoint-free survival did not differ between women and men (hospital-based follow-up HR for women versus men, 0.87, 95% CI 0.62-1.23; p = 0.44 and primary care service HR for women versus men 0.95, 95% CI 0.69-1.31; p = 0.78).

CONCLUSIONS

The study show no sex differences in achievement of secondary preventive targets or composite endpoint after coronary heart events. However, many women and men did not achieve treatment goals, and further improvement in secondary prevention is needed.

TRIAL REGISTRATION

The study is registered in ClinicalTrials.gov (NCT00679237).

摘要

背景与目的

一些研究指出心血管预防实践存在性别差异。本研究旨在探讨男性和女性在冠心病事件后的二级预防目标的实现情况和长期结局方面的差异。

方法

这是一项来自挪威 Sorlandet 医院基于医院和基于初级保健的二级预防随访的随机对照试验的亚分析，包括这两个组。主要结局是在指数事件发生后两年达到治疗目标。无事件生存是根据随访期间的死亡率、冠状动脉介入治疗、卒中和心肌梗死的复合结局计算得出的。参与者通过门诊咨询在指数事件后最多随访 10 年。

结果

共有 337 名女性和 1203 名男性符合研究条件。由于在指数冠心病事件后的头两年失去随访，106 名（7%）参与者被排除在进一步分析之外（53%的退出同意，12%的死亡和 35%的其他原因），留下 307 名（21%）女性和 1127 名（79%）男性。在两年的随访后，我们发现女性和男性在血压目标（61%与 59%；p=0.57）、LDL-胆固醇目标（64%与 69%；p=0.15）、糖尿病患者的 HbA1c 目标（49%与 45%；p=0.57）、不吸烟（79%与 81%；p=0.34）、健康饮食（14%与 13%；p=0.89）、体力活动（55%与 58%；p=0.38）、使用乙酰水杨酸（93%与 94%；p=0.39）和使用降脂治疗（92%与 94%；p=0.15）方面没有差异。在中位随访时间为 5.0[标准差 3.2]年后，女性和男性在复合终点方面没有差异（89[30.0%]与 345[30.6%]；p=0.58），女性和男性的复合终点无事件生存也没有差异（医院随访的女性与男性的 HR，0.87，95%置信区间 0.62-1.23；p=0.44，初级保健服务的 HR，女性与男性的 HR，0.95，95%置信区间 0.69-1.31；p=0.78）。