Lu Qianhong, Lv Junxing, Li Zhe, Ye Yunqing, Zhang Bin, Wang Weiwei, Zhao Qinghao, Zhang Haitong, Zhao Zhenyan, Wang Bincheng, Liu Qingrong, Yu Zikai, Duan Zhenya, Guo Shuai, Zhao Yanyan, Gao Runlin, Xu Haiyan, Wu Yongjian
Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People's Republic of China.
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100037, People's Republic of China.
Int J Gen Med. 2024 Nov 28;17:5651-5664. doi: 10.2147/IJGM.S498982. eCollection 2024.
Conventional cardiovascular risk factors may contribute to the development of valvular heart disease (VHD). The present study sought to investigate the distribution of conventional modifiable cardiovascular risk factors (smoking, hypertension, hyperlipidemia, and diabetes) in various VHDs, the impact of risk factors on outcomes, and the prognostic indicators in patients with distinct burdens of risk factors.
The study included 11862 patients with moderate or greater VHD. The primary outcome was a composite of all-cause mortality, hospitalization for heart failure, and myocardial infarction within two years.
Of 11862 patients with VHD, the mean age was 61.77 ± 13.51 years, and 44.4% were female. The prevalences of smoking, hypertension, hyperlipidemia, and diabetes were 14.9%, 45.0%, 13.4%, and 14.5% in the total cohort. Patients with zero, one, two, three, or four risk factors accounted for 39.4%, 38.2%, 17.7%, 4.3%, and 0.3%, respectively. The number of conventional risk factors was independently associated with two-year outcome in patients with mitral regurgitation (MR; three/four vs zero: hazard ratio [HR, 95% confidence interval (CI)]: 1.600 [1.106-2.315], P = 0.013; two vs zero: HR [95% CI]: 1.153 [0.867-1.532], P = 0.328; one vs zero: HR [95% CI]: 0.892 [0.687-1.159], P = 0.393). Stratified by the etiology of mitral valve lesions, each one risk factor increase was independently related to a 17.3% higher risk of adverse events in secondary MR. In patients with three or four risk factors, females had a significantly poorer outcome than males (P = 0.002).
More than one of five VHD patients had at least two conventional cardiovascular risk factors. The increasing number of risk factors indicated poor prognosis in patients with significant MR. Optimizing risk factor control may improve secondary prevention as well as long-term outcomes of VHD.
传统心血管危险因素可能促成心脏瓣膜病（VHD）的发生。本研究旨在调查各种心脏瓣膜病中传统可改变心血管危险因素（吸烟、高血压、高脂血症和糖尿病）的分布情况、危险因素对结局的影响以及不同危险因素负担患者的预后指标。
本研究纳入了11862例中度及以上心脏瓣膜病患者。主要结局为两年内全因死亡率、因心力衰竭住院和心肌梗死的复合结局。
在11862例心脏瓣膜病患者中，平均年龄为61.77±13.51岁，44.4%为女性。在整个队列中，吸烟、高血压、高脂血症和糖尿病的患病率分别为14.9%、45.0%、13.4%和14.5%。无、一、二、三或四个危险因素的患者分别占39.4%、38.2%、17.7%、4.3%和0.3%。在二尖瓣反流（MR）患者中，传统危险因素的数量与两年结局独立相关（三/四个危险因素与无危险因素相比：风险比[HR，95%置信区间（CI）]：1.600[1.106 - 2.315]，P = 0.013；两个危险因素与无危险因素相比：HR[95%CI]：1.153[0.867 - 1.532]，P = 0.328；一个危险因素与无危险因素相比：HR[95%CI]：0.892[0.687 - 1.159]，P = 0.393）。按二尖瓣病变病因分层，在继发性二尖瓣反流中，每增加一个危险因素，不良事件风险独立增加17.3%。在有三个或四个危险因素的患者中，女性的结局明显比男性差（P = 0.002）。
五分之一以上的心脏瓣膜病患者至少有两种传统心血管危险因素。危险因素数量增加表明重度二尖瓣反流患者预后不良。优化危险因素控制可能改善心脏瓣膜病的二级预防以及长期结局。
