COPD and incident cardiovascular disease hospitalizations and mortality: Kaiser permanente medical care program
COPD and incident cardiovascular disease hospitalizations and mortality: Kaiser permanente medical care program
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DOI：
10.1378/chest.128.4.2068
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发表时间：
2005-10-01
期刊：
影响因子：
9.6
通讯作者：
Eisner, MD
中科院分区：
文献类型：
--
作者：
Sidney, S;Sorel, M;Eisner, MD
研究目的：确定COPD诊断和治疗与心血管疾病（CVD）住院和死亡率之间的关系。设计：回顾性配对队列研究。设置：北方加州Kaiser Permanente医疗保健计划（KPNC），一个全面的预付综合医疗保健系统。患者或参与者：病例患者（n = 45，966）均为1996年1月至1999年12月4年期间确定的COPD KPNC成员。从KPNC成员中选择相同数量的无COPD的对照组，并匹配性别、出生年份和KPNC成员的长度。测量和结果：随访至2000年12月31日，对CVD终点的住院率和死亡率进行了随访。CVD研究终点包括心律失常、心绞痛、急性心肌梗死、充血性心力衰竭（CHF）、卒中、肺栓塞、所有上述研究终点的组合、其他CVD和所有CVD终点。病例组平均随访时间为2.75年，对照组平均随访时间为2.99年。在所有CVD住院和死亡终点，COPD病例患者的住院风险高于对照组。校正性别、既存CVD研究终点、高血压、高脂血症和糖尿病后，所有研究终点的复合指标的住院相对风险（RR）为2.09（95%置信区间[CI]，1.99 - 2.20），范围为1.33（卒中）-3.75（CHF）。所有研究终点复合指标的死亡率校正RR为1.68（95%CI，1.50 - 1.88），范围为1.25（卒中）-3.53（CHF）。年轻患者（即，年龄< 65岁）和女性患者的风险高于老年人和男性participator.Conclusions：COPD是一个预测CVD住院和死亡率超过平均随访时间近3年。在< 65岁的患者中，COPD与CVD结局的关系更强，这一发现表明，在年轻的COPD患者中，应特别小心地监测和治疗CVD风险。
Study objectives: To determine the relationship between diagnosed and treated COPD and the incidence of cardiovascular disease (CVD) hospitalization and mortality.Design: Retrospective matched cohort study.Setting: Northern California Kaiser Permanente Medical Care Program (KPNC), a comprehensive prepaid integrated health-care system.Patients or participants: Case patients (n = 45,966) were all KPNC members with COPD who were identified during a 4-year period from January 1996 through December 1999. An equal number of control subjects without COPD were selected from KPNC membership and were matched for gender, year of birth, and length of KPNC membership.Measurements and results: Follow-up conducted for hospitalization and mortality from CVD end points through December 31, 2000. CVD study end points included cardiac arrhythmias, angina pectoris, acute myocardial infarction, congestive heart failure (CHF), stroke, pulmonary embolism, all of the aforementioned study end points combined, other CVD, and all CVD end points. The mean follow-up time was 2.75 years for case patients and 2.99 years for control subjects. The risk of hospitalization was higher in COPD case patients than in control subjects for all CVD hospitalization and mortality end points. The relative risk (RR) for hospitalization for the composite measure of all study end points was 2.09 (95% confidence interval [CI], 1.99 to 2.20) after adjustment for gender, preexisting CVD study end points, hypertension, hyperlipidemia, and diabetes, and ranged from 1.33 (stroke) to 3.75 (CHF). The adjusted RR for mortality for the composite measure of all study end points was 1.68 (95% CI, 1.50 to 1.88), ranging from 1.25 (stroke) to 3.53 (CHF). Younger patients (ie, age < 65 years) and female patients had higher risks than older and male participants.Conclusions: COPD was a predictor of CVD hospitalization and mortality over an average follow-up time of nearly 3 years. The finding of a stronger relationship of COPD to CVD outcomes in patients < 65 years of age suggests that CVD risk should be monitored and treated with particular care in younger adults with COPD.