老年女性患者基线临床特征对远期缺血性心血管病事件的影响

Effect of baseline clinical characteristics of elderly female patients on their long-term ischemic cardiovascular events

目的探讨老年女性患者基线临床特征对远期缺血性心血管病预后的影响。方法选择2008年4月～2010年7月部分驻京部队干休所的老年患者614例,其中男性470例,女性144例。女性分为女性事件组43例和女性对照组101例,男性分为男性事件组127例和男性对照组343例。比较基线临床资料分布特征。随访4.5～6.7(5.6±0.9)年分析终点事件与临床因素的相关性。结果与男性比较,女性高血压(2级、3级)、高胆固醇血症、抗血小板药物、钙离子通道阻滞剂和降糖药物比例明显升高,吸烟、慢性肾功能不全、他汀类药物、硝酸盐类和血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂比例明显降低(P<0.05,P<0.01)。与女性对照组比较,女性事件组慢性肾功能不全比例明显升高(9.3%vs 1.0%,P=0.03)。与男性对照组比较,男性事件组年龄、冠心病、缺血性脑卒中、慢性阻塞性肺病和硝酸盐类比例明显升高(P<0.05,P<0.01)。Cox多因素回归分析显示,女性终点事件与冠心病(HR=2.56,95%CI:1.19～5.54,P=0.017)、高血压2级(HR=3.29,95%CI:1.14～9.52,P=0.028)、高血压3级(HR=2.77,95%CI:1.08～7.12,P=0.034),高胆固醇血症(HR=2.61,95%CI:1.27～5.36,P=0.009)和慢性肾功能不全(HR=22.70,95%CI:5.22～98.78,P=0.000)相关。而男性终点事件与年龄、冠心病和缺血性脑卒中相关(P<0.05,P<0.01)。结论老年患者在基线临床特征及其对远期缺血性心血管病事件的作用存在不同程度的性别差异。老年女性远期心血管病事件发生更多与心血管病高危因素相关联。

Objective To study the effect of baseline clinical characteristics of elderly female patients on their long-term ischemic cardiovascular events.Methods Of the 614 elderly patients admitted to our center from April 2008 to July 2010,144 elderly female patients were divided into female cardiovascular events group(n=43)and female control group(n=101),470 elderly male patients were divided into male cardiovascular events group(n=127)and male control group(n=343).Their baseline clinical characteristics were compared.The patients were followed up for 4.5-6.7(5.6±0.9)years,during which the relationship between first ever acute ischemic cardiovascular events and their clinical factors were analyzed.Results The incidence of grade 2 hypertension,grade 3 hypertension and hypercholesterolemia,the ratios of antiplatelet drug therapy,CCB therapy and hypoglycemic drug therapy were significantly higher while the history of smoking was significantly shorter,the incidence of chronic renal insufficiency and the ratios of statins therapy,nitrates therapy and ACEI/ARB therapy were significantly lower in female patients than in male patients.The incidence of chronic renal insufficiency was significantly higher in female cardiovascular events group than in female control group(9.3%vs 1.0%,P=0.03).The age was significantly older,the incidence of CHD,ischemic cerebral stroke,chronic obstructive pulmonary disease and the ratio of nitrates therapy were significantly higher in male cardiovascular events group than in male control group.Cox multivariate regression analysis showed that the endpoint events were related with CHD,grade 2 hypertension,grade 3 hypertension,hypercholesterolemia,chronic renal insufficiency in female patients(HR=2.56,95%CI:1.19-5.54,P=0.017;HR=3.29,95%CI:1.14-9.52,P=0.028;HR=2.77,95%CI:1.08-7.12,P=0.034;HR=2.61,95%CI:1.27-5.36,P=0.009;HR=22.70,95%CI:5.22-98.78,P=0.000)and were related with age,CHD and ischemic cerebral stroke in male patients(P<0.05,P<0.01).Conclusion The effect of baseline clinical characteristics of elderly patients on their long-term ischemic cardiovascular events is different in males and females.The incidence of long-term cardiovascular events is closely related with the risk factors for cardiovascular disease in elderly females.