Division of Nephrology and Hypertension, Department of Internal Medicine University of Cincinnati Cincinnati OH USA.
Department of Environmental Health University of Cincinnati Cincinnati OH USA.
J Am Heart Assoc. 2024 May 7;13(9):e029691. doi: 10.1161/JAHA.123.029691. Epub 2024 May 3.
Cardiovascular disease is the leading cause of mortality in patients with kidney failure, and their risk of cardiovascular events is 10 to 20 times higher as compared with the general population.
We evaluated 508 822 patients who initiated dialysis between January 1, 2005 and December 31, 2014 using the United States Renal Data System with linked Medicare claims. We determined hospitalization rates for cardiovascular events, defined by acute coronary syndrome, heart failure, and stroke. We examined the association of sex with outcome of cardiovascular events, cardiovascular death, and all-cause death using adjusted time-to-event models. The mean age was 70±12 years and 44.7% were women. The cardiovascular event rate was 232 per thousand person-years (95% CI, 231-233), with a higher rate in women than in men (248 per thousand person-years [95% CI, 247-250] versus 219 per thousand person-years [95% CI, 217-220]). Women had a 14% higher risk of cardiovascular events than men (hazard ratio [HR], 1.14 [95% CI, 1.13-1.16]). Women had a 16% higher risk of heart failure (HR, 1.16 [95% CI, 1.15-1.18]), a 31% higher risk of stroke (HR, 1.31 [95% CI, 1.28-1.34]), and no difference in risk of acute coronary syndrome (HR, 1.01 [95% CI, 0.99-1.03]). Women had a lower risk of cardiovascular death (HR, 0.89 [95% CI, 0.88-0.90]) and a lower risk of all-cause death than men (HR, 0.96 [95% CI, 0.95-0.97]).
Among patients undergoing dialysis, women have a higher risk of cardiovascular events of heart failure and stroke than men. Women have a lower adjusted risk of cardiovascular mortality and all-cause mortality.
心血管疾病是肾衰竭患者死亡的主要原因，其发生心血管事件的风险比普通人群高 10 至 20 倍。
我们使用美国肾脏数据系统（United States Renal Data System）和医疗保险索赔数据（Medicare claims），评估了 2005 年 1 月 1 日至 2014 年 12 月 31 日期间开始透析的 508822 名患者。我们确定了心血管事件（急性冠状动脉综合征、心力衰竭和中风）的住院率。我们使用调整后的时间事件模型，研究了性别与心血管事件结果、心血管死亡和全因死亡的关系。平均年龄为 70±12 岁，44.7%为女性。心血管事件发生率为每千人每年 232 例（95%可信区间，231-233），女性发生率高于男性（每千人每年 248 例[95%可信区间，247-250]与每千人每年 219 例[95%可信区间，217-220]）。女性发生心血管事件的风险比男性高 14%（风险比[HR]，1.14[95%可信区间，1.13-1.16]）。女性心力衰竭的风险增加 16%（HR，1.16[95%可信区间，1.15-1.18]），中风的风险增加 31%（HR，1.31[95%可信区间，1.28-1.34]），急性冠状动脉综合征的风险无差异（HR，1.01[95%可信区间，0.99-1.03]）。女性心血管死亡的风险较低（HR，0.89[95%可信区间，0.88-0.90]），全因死亡的风险也低于男性（HR，0.96[95%可信区间，0.95-0.97]）。
在接受透析的患者中，女性发生心力衰竭和中风等心血管事件的风险高于男性。女性调整后的心血管死亡率和全因死亡率较低。
