Hu Jiaman, Chi Jianing, Cai Hua, Wu Ningxia, Li Pengfei, Huang Yuekang, Lin Cailong, Lai Yingying, Huang Jianyu, Li Weihua, Su Peng, Li Min, Lin Zhongqiu, Xu Lin
Department of Geriatric Cardiology & Branch of National Clinical Research Center for Geriatric Diseases & Guangzhou Key Laboratory of Cardiac Rehabilitation, General Hospital of Southern Theater Command, Guangzhou, China.
School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China.
Front Cardiovasc Med. 2024 Apr 12;11:1342379. doi: 10.3389/fcvm.2024.1342379. eCollection 2024.
The long-term prognosis of patients with stable coronary artery disease (CAD) combined with orthostatic hypotension (OH) has rarely been reported. This research was designed to examine whether OH increases the risk of all-cause mortality and cardiovascular death among patients with stable CAD.
We retrospectively analyzed retired military personnel over 65 years of age who were hospitalized at the General Hospital of Southern Theater Command of the Chinese People's Liberation Army between March and July 2010. A total of 924 patients with stable CAD were included, among whom 263 had OH. The risk of all-cause mortality and cardiovascular death in OH and non-OH groups were analyzed with the Cox proportional hazards models, and restricted cubic spline plots were utilized for subgroup analyses. Furthermore, competing risk models were applied for sensitivity analyses.
The median age of the patients was 82.00 (80.00-85.00) years. Over 159 months of follow-up, the loss to follow-up rate was 2.27%, and all-cause mortality was observed in 574 (63.57%) patients, including 184 with OH. Moreover, cardiovascular death occurred in 127 patients (13.73%), with 58 cases associated with OH. Although the relationship between OH and all-cause mortality was non-significant [body mass index (BMI) < 25 group, adjusted hazard ratio (HR) = 1.10 with a 95% confidence interval (CI): 0.82-1.40; BMI ≥ 25 group, adjusted HR = 1.30, 95% CI: 0.98-1.70], it was independently related to a growing risk of cardiovascular death (adjusted HR = 1.80, 95% CI: 1.20-2.60). This finding was further validated by using a competing risk model (subdistribution HR = 1.74, 95% CI: 1.22-2.49). Moreover, age, low-density lipoprotein cholesterol, and frequency of hospital admissions were identified as risk factors of cardiovascular death among patients with OH ( < 0.05).
Our study, based on retired military personnel with stable CAD, found that OH led to a significantly higher risk of cardiovascular death, but it was not noticeably associated with all-cause mortality on long-term prognosis.
稳定型冠状动脉疾病（CAD）合并体位性低血压（OH）患者的长期预后鲜有报道。本研究旨在探讨OH是否会增加稳定型CAD患者的全因死亡率和心血管死亡风险。
我们回顾性分析了2010年3月至7月在中国人民解放军南部战区总医院住院的65岁以上退休军人。共纳入924例稳定型CAD患者，其中263例患有OH。采用Cox比例风险模型分析OH组和非OH组的全因死亡率和心血管死亡风险，并利用限制立方样条图进行亚组分析。此外，应用竞争风险模型进行敏感性分析。
患者的中位年龄为82.00（80.00 - 85.00）岁。在超过159个月的随访中，失访率为2.27%，574例（63.57%）患者出现全因死亡，其中184例患有OH。此外，127例患者（13.73%）发生心血管死亡，其中58例与OH相关。虽然OH与全因死亡率之间的关系不显著[体重指数（BMI）<25组，调整后风险比（HR）=1.10，95%置信区间（CI）：0.82 - 1.40；BMI≥25组，调整后HR = 1.30，95%CI：0.98 - 1.70]，但它与心血管死亡风险增加独立相关（调整后HR = 1.80，95%CI：1.20 - 2.60）。使用竞争风险模型进一步验证了这一发现（亚分布HR = 1.74，95%CI：1.22 - 2.49）。此外，年龄、低密度脂蛋白胆固醇和住院频率被确定为OH患者心血管死亡的危险因素（<0.05）。
我们基于患有稳定型CAD的退休军人的研究发现，OH导致心血管死亡风险显著升高，但在长期预后方面与全因死亡率无明显关联。
