解放军医学院学报2025，Vol.46Issue(6)：539-545,582,8.DOI:10.12435/j.issn.2095-5227.25010704
老年高血压合并冠心病患者心血管代谢性共病流行特征及预后研究
Clinical characteristics and prognosis of cardiometabolic multimorbidity in elderly patients with hypertension and coronary artery heart disease
摘要
Abstract
Background The proportion of elderly patients with hypertension and coronary artery disease(HT-CAD)is high.Cardiometabolic disease(CMD)has gradually become the most common coexistence mode of multiple diseases among elderly people in China.The epidemic trend and prognosis of CMD in elderly patients with HT-CAD is rarely studied.Objective To explore the clinical characteristics and prognosis of cardiometabolic disease in elderly patients with HT-CAD.Methods From July 2008 to July 2018,elderly inpatients(aged≥65 years)with HT-CAD from Department of Cardiology of PLA General Hospital were included in the study.All patients were followed up until September 2023,and divided into four groups,including HT-CAD group,HT-CAD combined with stroke(HT-CAD-STR)group,HT-CAD combined with diabetes(HT-CAD-DM)group,HT-CAD with stroke and diabetes(HT-CAD-STR-DM)group.Cox regression model was used to calculate the hazard ratio(HR)and 95%confidence interval(CI)of all-cause mortality in each group.Results A total of 8 258 patients were included in this study,including 3 454 patients(41.83%)in the HT-CAD group,884 patients(10.70%)in the HT-CAD-STR group,3 054 patients(36.98%)in the HT-CAD-DM group and 866 patients(10.49%)in the HT-CAD-STR-DM group.From 2008 to 2018,the proportion of HT-CAD patients decreased(45.52%vs 38.88%),and the proportion of HT-CAD-STR-DM patients increased(8.38%vs 12.53%)(Pfor trend<0.01).Compared with the other three groups,patients in the HT-CAD-STR-DM group had faster heart rate,higher body mass index,lower level of high-density lipoprotein,and higher proportion of heart failure(HF),chronic kidney disease(CKD)and acute myocardial infarction(AMI).After a median follow-up of 6.38 years,a total of 6 843 patients completed the follow-up,1 281 cases of death were identified.The number of events and their incidence for the four groups of patients were as follows:HT-CAD group:435/2 885,23.55 per 1 000 person-years;HT-CAD-STR group:125/743,26.36 per 1 000 person-years;HT-CAD-DM group:530/2 499,33.24 per 1 000 person-years;HT-CAD-STR-DM group:191/716,41.82 per 1 000 person-years.Multivariate Cox regression model showed that the HR(95%CI)of all-cause mortality were 1.38(1.21-1.57)for the HT-CAD-DM patients and 1.73(1.45-2.05)for the HT-CAD-STR-DM patients compared to those with HT-CAD,while the risk of all-cause mortality did not significantly increase in the HT-CAD-STR patients.Stratified analysis by diabetes showed that stroke was not associated with increased risk of all-cause death in elderly patients with HT-CAD,but increased the risk by 26%in elderly HT-CAD-DM patients.Moreover,stratified analysis by stroke showed that diabetes increased the risk of all-cause mortality by 39%in elderly HT-CAD,but increased the risk by 71%in elderly HT-CAD-STR patients.Conclusion The prevalence of cardiometabolic disease is high among elderly HT-CAD patients and it keeps increasing year by year.Elderly HT-CAD patients with diabetes have higher risk of all-cause mortality.Diabetes and stroke show synergistic effects on the risk of all-cause death in elderly HT-CAD patients.关键词
老年人/高血压/冠心病/心血管代谢性共病/流行病学/预后Key words
the aged/hypertension/coronary artery heart disease/cardiometabolic disease/epidemiology/prognosis分类
临床医学引用本文复制引用
兰丽花,汪驰,李雁洁,冯泽锟,田露,赵茂翔,葛振,黄建翔,薛浩..老年高血压合并冠心病患者心血管代谢性共病流行特征及预后研究[J].解放军医学院学报,2025,46(6):539-545,582,8.基金项目
首都卫生发展科研专项(首发2020-2-5013) （首发2020-2-5013）
