Objective: To assess whether use of oral glucocorticoids is associated with ca rdiovascular and cerebrovascular morbidity. Design and setting: Nested case-con trol study within a cohort of patients (≥50 years old) wi...Objective: To assess whether use of oral glucocorticoids is associated with ca rdiovascular and cerebrovascular morbidity. Design and setting: Nested case-con trol study within a cohort of patients (≥50 years old) with at least one prescr iption for oral or non-systemic glucocorticoids. Data were from the general pra ctice research database. Patients: 50 656 patients were identified with a first record for ischaemic heart disease (International classification of diseases, ni nth revision (ICD-9) codes 410, 411, 413, and 414), ischaemic stroke or transie nt ischaemic attack (ICD-9 codes 430-436), or heart failure (ICD-9 code 428) between 1988 and 1998. One control was matched to each case by sex, age, general practice, underlying disease, and calendar time. Main outcome measure: Odds rat io (OR) of cardiovascular or cerebrovascular events in patients using oral gluco corticoids compared with non-users. Results: There was a significant associatio n between ever use of oral glucocorticoids and any cardiovascular or cerebrovasc ular outcome (adjusted OR 1.25, 95%confidence interval (CI) 1.21 to 1.29). The association was stronger for current use of oral glucocorticoids than for recent or past use. Among current users, the highest ORs were observed in the group wi th the highest average daily dose, although the dose-response relation was not continuous. Current use was associated with an increased risk of heart failure ( adjusted OR 2.66, 95%CI 2.46 to 2.87), which was consistent between patients wi th rheumatoid arthritis, patients with chronic obstructive pulmonary disease, an d patients without either of the two conditions. Also, current use was associate d with a smaller increased risk of ischaemic heart disease (OR 1.20, 95%CI 1.11 to 1.29). Conclusions: Oral glucocorticoid use was identified as a risk factor for heart failure. However, the evidence remains observational and only a random ised controlled trial of glucocorticoid treatment versus other disease modifying agents is likely to distinguish the importance of the underlying disease activi ty from its treatment in predicting cardiovascular outcomes.展开更多
随着社会进步和医学的发展,人口老龄化、疾病谱的改变以及人们对健康需要的提高,健康和医学模式发生了转变.在这种背景下,生存质量(quality of life,QOL)作为一套评价健康水平的新型指标体系,近20年来已成为国际性的研究热点.充血性心...随着社会进步和医学的发展,人口老龄化、疾病谱的改变以及人们对健康需要的提高,健康和医学模式发生了转变.在这种背景下,生存质量(quality of life,QOL)作为一套评价健康水平的新型指标体系,近20年来已成为国际性的研究热点.充血性心力衰竭(congestive heart failure,CHF)目前已成为一个严重影响人类健康的重大疾病,而CHF患者QOL的评价研究对于制订并实施防治策略、指导康复治疗、预后估计等都具有重要的作用,但目前国内对此的认识与发达国家还有很大的差距.因此,本文阐述国内外在该领域的一些最新进展,以促进我们对该领域的进一步认识.展开更多
文摘Objective: To assess whether use of oral glucocorticoids is associated with ca rdiovascular and cerebrovascular morbidity. Design and setting: Nested case-con trol study within a cohort of patients (≥50 years old) with at least one prescr iption for oral or non-systemic glucocorticoids. Data were from the general pra ctice research database. Patients: 50 656 patients were identified with a first record for ischaemic heart disease (International classification of diseases, ni nth revision (ICD-9) codes 410, 411, 413, and 414), ischaemic stroke or transie nt ischaemic attack (ICD-9 codes 430-436), or heart failure (ICD-9 code 428) between 1988 and 1998. One control was matched to each case by sex, age, general practice, underlying disease, and calendar time. Main outcome measure: Odds rat io (OR) of cardiovascular or cerebrovascular events in patients using oral gluco corticoids compared with non-users. Results: There was a significant associatio n between ever use of oral glucocorticoids and any cardiovascular or cerebrovasc ular outcome (adjusted OR 1.25, 95%confidence interval (CI) 1.21 to 1.29). The association was stronger for current use of oral glucocorticoids than for recent or past use. Among current users, the highest ORs were observed in the group wi th the highest average daily dose, although the dose-response relation was not continuous. Current use was associated with an increased risk of heart failure ( adjusted OR 2.66, 95%CI 2.46 to 2.87), which was consistent between patients wi th rheumatoid arthritis, patients with chronic obstructive pulmonary disease, an d patients without either of the two conditions. Also, current use was associate d with a smaller increased risk of ischaemic heart disease (OR 1.20, 95%CI 1.11 to 1.29). Conclusions: Oral glucocorticoid use was identified as a risk factor for heart failure. However, the evidence remains observational and only a random ised controlled trial of glucocorticoid treatment versus other disease modifying agents is likely to distinguish the importance of the underlying disease activi ty from its treatment in predicting cardiovascular outcomes.
文摘随着社会进步和医学的发展,人口老龄化、疾病谱的改变以及人们对健康需要的提高,健康和医学模式发生了转变.在这种背景下,生存质量(quality of life,QOL)作为一套评价健康水平的新型指标体系,近20年来已成为国际性的研究热点.充血性心力衰竭(congestive heart failure,CHF)目前已成为一个严重影响人类健康的重大疾病,而CHF患者QOL的评价研究对于制订并实施防治策略、指导康复治疗、预后估计等都具有重要的作用,但目前国内对此的认识与发达国家还有很大的差距.因此,本文阐述国内外在该领域的一些最新进展,以促进我们对该领域的进一步认识.
