Matsunaga Masaaki, Tanihara Shinichi, He Yupeng, Yatsuya Hiroshi, Ota Atsuhiko
Department of Public Health, Fujita Health University School of Medicine, Toyoake, Japan.
Department of Public Health, School of Medicine, Kurume University, Kurume, Japan.
J Alzheimers Dis. 2025 Feb;103(3):749-757. doi: 10.1177/13872877241305813. Epub 2025 Jan 10.
Research on the influence of heart failure on mortality after Alzheimer's disease diagnosis is limited.
To evaluate the association between comorbid heart failure and mortality following Alzheimer's disease diagnosis, particularly considering sex differences.
We analyzed administrative claims data from Japan, involving 32,363 individuals (11,064 men and 21,299 women) aged 75 or older newly diagnosed with Alzheimer's disease, with 7% having comorbid heart failure. Cox proportional hazard models and population attributable fractions (PAFs) were used to evaluate the association between comorbid heart failure and mortality within one year following Alzheimer's disease diagnosis.
Individuals with Alzheimer's disease and heart failure had a multivariate-adjusted hazard ratio of 1.51 (95% confidence interval [CI], 1.32-1.73) for mortality during the one-year follow-up period compared to those with Alzheimer's disease and without heart failure. Subgroup analysis by sex revealed a higher mortality hazard ratio in women of 1.63 (95% CI, 1.36-1.95) than that in men of 1.39 (95% CI, 1.13-1.71). Further age and sex subgroup analysis indicated that women across all age brackets-75-79, 80-84, and ≥ 85 years-had higher mortality hazard ratios. The PAF for heart failure increased with age in both sexes, with women having higher PAFs than men, and the sex difference in PAF being most pronounced in the 75-79 age category (men: 1.4%, women: 4.0%).
Hazard ratios and PAFs for mortality associated with comorbid heart failure in newly diagnosed Alzheimer's disease are higher in women than in men, which persists across all age subgroups.
关于心力衰竭对阿尔茨海默病诊断后死亡率影响的研究有限。
评估合并心力衰竭与阿尔茨海默病诊断后死亡率之间的关联，尤其考虑性别差异。
我们分析了来自日本的行政索赔数据，涉及32363名75岁及以上新诊断为阿尔茨海默病的个体（11064名男性和21299名女性），其中7%合并心力衰竭。采用Cox比例风险模型和人群归因分数（PAF）来评估合并心力衰竭与阿尔茨海默病诊断后一年内死亡率之间的关联。
与未合并心力衰竭的阿尔茨海默病患者相比，合并心力衰竭的阿尔茨海默病患者在一年随访期内的多变量调整风险比为1.51（95%置信区间[CI]，1.32 - 1.73）。按性别进行的亚组分析显示，女性的死亡风险比更高，为1.63（95%CI，1.36 - 1.95），高于男性的1.39（95%CI，1.13 - 1.71）。进一步按年龄和性别进行的亚组分析表明，所有年龄组（75 - 79岁、80 - 84岁和≥85岁）的女性死亡风险比都更高。心力衰竭的PAF在两性中均随年龄增加，女性的PAF高于男性，且PAF的性别差异在75 - 79岁年龄组最为明显（男性：1.4%，女性：4.0%）。
新诊断的阿尔茨海默病患者中，合并心力衰竭相关的死亡率风险比和PAF在女性中高于男性，且在所有年龄亚组中均持续存在。
