BHF/University Centre for Cardiovascular Science, Little France Crescent, University of Edinburgh, Edinburgh EH16 4SA, UK.
Division of Population Health and Genomics, University of Dundee, Dundee, UK.
Eur Heart J. 2024 Apr 14;45(15):1339-1351. doi: 10.1093/eurheartj/ehae080.
Patients with kidney failure have a higher risk of cardiovascular disease compared with the general population. Whilst temporal trends of myocardial infarction and stroke are declining in the general population, these have not been evaluated in patients with kidney failure. This study aimed to describe national trends in the incidence, treatment, and outcomes of myocardial infarction and stroke in patients with kidney failure (i.e. on dialysis or with a kidney transplant) over a 20-year period, stratified by age and sex.
In this retrospective national data linkage study, all patients with kidney failure in Scotland (UK) receiving kidney replacement therapy between January 1996 and December 2016 were linked to national hospitalization, prescribing, and death records. The primary outcomes were the incidence of myocardial infarction and stroke, and subsequent cardiovascular death. Generalized additive models were constructed to estimate age-standardized, sex-stratified incidence rates and trends in cardiovascular and all-cause death.
Amongst 16 050 patients with kidney failure [52 (SD 15) years; 41.5% women], there were 1992 [66 (SD 12) years; 34.8% women] and 996 [65 (SD 13) years; 45.1% women] incident myocardial infarctions and strokes, respectively, between January 1996 and December 2016. During this period, the age-standardized incidence of myocardial infarction per 100 000 decreased in men {from 4376 [95% confidence interval (CI) 3998-4785] to 1835 (95% CI 1692-1988)} and women [from 3268 (95% CI 2982-3593) to 1369 (95% CI 1257-1491)]. Similarly, the age-standardized incidence of stroke per 100 000 also decreased in men [from 1978 (95% CI 1795-2175) to 799 (95% CI 729-875)] and women [from 2234 (95% CI 2031-2468) to 903 (95% CI 824-990)]. Compared with the general population, the incidence of myocardial infarction was four- to eight-fold higher in patients with kidney failure, whilst for stroke it was two- to four-fold higher. The use of evidence-based cardioprotective treatment increased over the study period, and the predicted probability of cardiovascular death within 1 year of myocardial infarction for a 66-year-old patient with kidney failure (mean age of the cohort) fell in men (76.6% to 38.6%) and women (76.8% to 38.8%), and also decreased in both sexes following stroke (men, from 63.5% to 41.4%; women, from 67.6% to 45.8%).
The incidence of myocardial infarction and stroke has halved in patients with kidney failure over the past 20 years but remains significantly higher than in the general population. Despite improvements in treatment and outcomes, the prognosis of these patients following myocardial infarction and stroke remains poor.
与普通人群相比，肾衰竭患者患心血管疾病的风险更高。虽然普通人群中心肌梗死和中风的发病率呈下降趋势，但在肾衰竭患者中尚未进行评估。本研究旨在描述 20 年来苏格兰（英国）所有接受肾脏替代治疗的肾衰竭患者（即透析或肾移植患者）中心肌梗死和中风的发病率、治疗和结局的变化趋势，并按年龄和性别进行分层。
在这项回顾性全国性数据关联研究中，苏格兰所有接受肾脏替代治疗的肾衰竭患者（1996 年 1 月至 2016 年 12 月）与全国住院、处方和死亡记录进行关联。主要结局为心肌梗死和中风的发生率以及随后的心血管死亡。使用广义加性模型估计标准化年龄、性别分层的心血管和全因死亡率的发病率和趋势。
在 16050 例肾衰竭患者中[52（SD 15）岁；41.5%为女性]，1996 年 1 月至 2016 年 12 月期间分别发生了 1992 例[66（SD 12）岁；34.8%为女性]和 996 例[65（SD 13）岁；45.1%为女性]心肌梗死和中风事件。在此期间，男性每 100000 人中心肌梗死的标准化发病率从 4376[95%置信区间（CI）3998-4785]降至 1835（95%CI 1692-1988），女性从 3268[95%CI 2982-3593]降至 1369（95%CI 1257-1491）。同样，男性每 100000 人中中风的标准化发病率从 1978[95%CI 1795-2175]降至 799（95%CI 729-875），女性从 2234[95%CI 2031-2468]降至 903（95%CI 824-990）。与普通人群相比，肾衰竭患者心肌梗死的发病率是普通人群的 4 至 8 倍，而中风的发病率则是普通人群的 2 至 4 倍。在研究期间，循证心脏保护治疗的使用率有所增加，对于 66 岁的肾衰竭患者（队列平均年龄），心肌梗死后 1 年内心血管死亡的预测概率从 76.6%降至 38.6%，男性（76.8%降至 38.8%）和女性（76.6%降至 38.8%）均有所下降，中风后也有所下降（男性从 63.5%降至 41.4%；女性从 67.6%降至 45.8%）。
过去 20 年来，肾衰竭患者心肌梗死和中风的发病率下降了一半，但仍明显高于普通人群。尽管治疗和结局有所改善，但这些患者在心肌梗死和中风后的预后仍然很差。
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