Gender differences in pre-event health status of young patients with acute myocardial infarction: A VIRGO study analysis.
Gender differences in pre-event health status of young patients with acute myocardial infarction: A VIRGO study analysis.
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DOI：
10.1177/2048872615568967
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发表时间：
2016-02
期刊：
影响因子：
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通讯作者：
Spertus JA
中科院分区：
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作者：
Dreyer RP;Smolderen KG;Strait KM;Beltrame JF;Lichtman JH;Lorenze NP;D'Onofrio G;Bueno H;Krumholz HM;Spertus JA
我们评估了年轻急性心肌梗死（AMI）患者事件前健康状况（症状、功能、生活质量）的性别差异，以及在对重要协变量进行序贯调整后，这种相关性是否持续存在。我们还评估了性别和既往冠状动脉疾病（CAD）之间的相互作用，因为积极的症状控制是已知冠心病患者护理的基石。从103家美国/24家西班牙医院（2008-2012年）共招募了3，501例年龄在18-55岁之间的AMI患者（2，349例女性）。临床/健康状况信息通过病历摘要和患者访谈获得。通过通用[简表-12（SF-12）、EuroQoL [EQ-5D）]和疾病特异性[西雅图心绞痛问卷（SAQ）]测量来测量事件前健康状态。采用T检验/卡方检验和多变量线性/逻辑回归分析，依次调整协变量。女性的合并症较多，且一般平均健康评分显著低于男性[SF-12身体健康=43±12 vs. 46±11，心理健康= 44±13 vs. 48±11]; EQ-5D效用指数=0.7±0.2 vs. 0.8±0.2，视觉模拟量表=63±22 vs. 67±20，P均<0.0001。他们的疾病特异性健康状况也更差，心绞痛更多[SAQ心绞痛频率=83±22 vs. 87±18]，身体功能更差[身体限制=78±27 vs. 87±21]，生活质量更差[55±25 vs. 60±22，P均<0.0001]。在多变量分析中，女性性别与更差的一般身体/心理健康之间的关联持续存在，以及更差的疾病特异性身体限制和生活质量。性别和既往CAD之间的相互作用在任何健康状况结局中均不显著。与男性相比，年轻女性的事件前健康状况更差，无论其CAD病史如何。虽然未来的性别差异的研究应调整基线健康状况，可能存在的机会，以更好地解决事件前的健康状况的妇女在AMI的风险。
We assessed gender differences in pre-event health status (symptoms, functioning, quality of life) in young patients with acute myocardial infarction (AMI), and whether or not this association persists following sequential adjustment for important covariates. We also evaluated the interaction between gender and prior coronary artery disease (CAD), given that aggressive symptom control is a cornerstone of care in those with known coronary disease. A total of 3,501 AMI patients (2,349 women) aged 18–55 years were enrolled from 103 United States/24 Spanish hospitals (2008–2012). Clinical/health status information was obtained by medical record abstraction and patient interviews. Pre-event health status was measured by generic [Short Form-12 (SF-12), EuroQoL [EQ-5D)] and disease-specific [Seattle angina questionnaire (SAQ)] measures. T-test/chi-square and multivariable linear/logistic regression analysis was utilized, sequentially adjusting for covariates. Women had more co-morbidities and significantly lower generic mean health scores than men [SF-12 physical health =43±12 vs. 46±11 and mental health= 44±13 vs. 48±11]; EQ-5D utility index=0.7±0.2 vs. 0.8±0.2, and visual analog scale=63±22 vs. 67±20, P<0.0001 for all. Their disease-specific health status was also worse, with more angina [SAQ angina frequency=83±22 vs. 87±18], worse physical function [physical limitation=78±27 vs. 87±21] and poorer quality of life [55±25 vs. 60±22, P<0.0001 for all]. In multivariable analysis, the association between female gender and worse generic physical/mental health persisted, as well as worse disease-specific physical limitation and quality of life. The interaction between gender and prior CAD was not significant in any of the health status outcomes. Young women have worse pre-event health status as compared with men, regardless of their CAD history. While future studies of gender differences should adjust for baseline health status, an opportunity may exist to better address the pre-event health status of women at risk for AMI.