Orencia A, Bailey K, Yawn B P, Kottke T E
Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905.
JAMA. 1993 May 12;269(18):2392-7.
To determine the effects of female gender on long-term survival and subsequent coronary heart disease events in a population developing first clinical manifestations of coronary artery disease.
Follow-up of all Rochester, Minn, residents first diagnosed with either angina pectoris or myocardial infarction/sudden unexpected death between January 1, 1960, and December 31, 1979.
Patients with angina pectoris were followed up through 1982 for survival and time to initial myocardial infarction/cardiac death. Patients with myocardial infarction were followed up through 1982 for survival and time to recurrent myocardial infarction/cardiac death.
Angina pectoris was the initial diagnosis for 529 women and 504 men. Myocardial infarction or sudden unexpected death was the initial diagnosis for 611 women and 997 men. The average age of patients diagnosed with angina pectoris was 67.0 years (SE, 0.5 years) for women and 60.0 years (SE, 0.5 years) for men. The average age of patients diagnosed with myocardial infarction/sudden unexpected death was 71.9 years (SE, 0.5 years) for women and 62.0 years (SE, 0.4 years) for men. Women presenting with angina pectoris survived significantly longer and had a lower incidence of subsequent myocardial infarction/cardiac death compared with men of similar age (P < .01). When rates of myocardial infarction and sudden unexpected death were combined to assess all cardiac endpoints with objective criteria ("hard" endpoints), women presenting with myocardial infarction/sudden unexpected death had survival rates and risk of subsequent myocardial infarction/coronary death that were similar to men of the same age. When survival following myocardial infarction was analyzed separately, survival also did not vary by gender.
In this population, women with angina pectoris as an initial diagnosis, but not those with myocardial infarction or sudden unexpected death, have longer survival and lower risk of subsequent myocardial infarction/cardiac death than do men with the same presentation and of a similar age.
确定女性性别对首次出现冠状动脉疾病临床表现人群的长期生存及后续冠心病事件的影响。
对1960年1月1日至1979年12月31日期间首次被诊断为心绞痛或心肌梗死/意外猝死的明尼苏达州罗切斯特市所有居民进行随访。
对心绞痛患者随访至1982年，观察生存情况及首次发生心肌梗死/心源性死亡的时间。对心肌梗死患者随访至1982年，观察生存情况及再次发生心肌梗死/心源性死亡的时间。
心绞痛为初始诊断的女性有529例，男性有504例。心肌梗死或意外猝死为初始诊断的女性有611例，男性有997例。诊断为心绞痛的患者，女性平均年龄为67.0岁（标准误，0.5岁），男性为60.0岁（标准误，0.5岁）。诊断为心肌梗死/意外猝死的患者，女性平均年龄为71.9岁（标准误，0.5岁），男性为62.0岁（标准误，0.4岁）。与年龄相仿的男性相比，以心绞痛就诊的女性存活时间显著更长，后续发生心肌梗死/心源性死亡的发生率更低（P < 0.01）。当将心肌梗死和意外猝死发生率合并，以客观标准评估所有心脏终点事件（“硬”终点）时，以心肌梗死/意外猝死就诊的女性生存率及后续发生心肌梗死/冠状动脉死亡的风险与同龄男性相似。单独分析心肌梗死后的生存情况时，生存情况也未因性别而异。
在该人群中，初始诊断为心绞痛的女性，而非初始诊断为心肌梗死或意外猝死的女性，与有相同临床表现且年龄相仿的男性相比，存活时间更长，后续发生心肌梗死/心源性死亡的风险更低。
