Predictors of heart failure among women with coronary disease
Predictors of heart failure among women with coronary disease
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DOI：
10.1161/01.cir.0000141726.01302.83
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发表时间：
2004-09-14
期刊：
影响因子：
37.8
通讯作者：
Shlipak, MG
中科院分区：
文献类型：
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作者：
Bibbins-Domingo, K;Lin, F;Shlipak, MG
背景 - 尽管心力衰竭在患有冠心病的女性中很常见，但导致心力衰竭的危险因素尚未得到充分研究。我们确定了已患冠心病的绝经后女性发生心力衰竭的危险因素。
方法和结果 - 这是一项前瞻性队列研究，使用了心脏和雌激素/孕激素替代研究（HERS）的数据，该研究是一项为期4.1年的随机、双盲、安慰剂对照试验，并在1993年至2000年期间于美国20个临床中心进行了为期2.7年的后续开放标签观察随访（HERS II）。在HERS试验的2763名已患冠心病的绝经后女性中，我们通过自我报告和体格检查研究了基线时无心力衰竭的2391名女性。本分析的主要结局是因心力衰竭入院或死亡所定义的心力衰竭事件。在6.3±1.4年的随访期间，237名女性（10%）发生了心力衰竭。确定了9个预测因素：糖尿病（定义为自我报告有正在治疗的糖尿病病史）、心房颤动、心肌梗死、肌酐清除率<30 mL/min、收缩压≥120 mmHg、当前吸烟、体重指数>35 kg/m²、左束支传导阻滞和左心室肥厚。随机分配接受雌激素/孕激素治疗与心力衰竭无关（风险比 = 1.0；95%置信区间，0.7 - 1.3）。糖尿病是最强的危险因素（调整后的风险比 = 3.1；95%置信区间，2.3 - 4.2）。体重指数升高或肌酐清除率降低的糖尿病女性风险最高，年发病率分别为7%和13%。在糖尿病女性中，高血糖与心力衰竭风险相关（调整后的风险比 = 3.0；95%置信区间，1.2 - 7.5，空腹血糖>300 mg/dL与空腹血糖80 - 150 mg/dL相比）。
结论 - 我们确定了患有冠心病的绝经后女性发生心力衰竭的9个预测因素。糖尿病是最强的危险因素，尤其是当控制不佳或伴有肾功能不全或肥胖时。
Background-Although heart failure is common among women with coronary disease, the risk factors for developing heart failure have not been well studied. We determined the risk factors for developing heart failure among postmenopausal women with established coronary disease.Methods and Results-This is a prospective cohort study using data from the Heart and Estrogen/progestin Replacement Study (HERS), a randomized, blinded, placebo-controlled trial of 4.1 years' duration, and subsequent open-label observational follow-up for 2.7 years (HERS II), performed at 20 US clinical centers between 1993 and 2000. Of the 2763 postmenopausal women with established coronary disease in the HERS trial, we studied the 2391 women with no heart failure at baseline by self-report and physical examination. The primary outcome of this analysis was incident heart failure defined by hospital admission or death from heart failure. During the 6.3+/-1.4-year follow-up, 237 women (10%) developed heart failure. Nine predictors were identified: diabetes (defined as a self-reported history of diabetes on treatment), atrial fibrillation, myocardial infarction, creatinine clearance 120 mm Hg, current smoking, body mass index >35 kg/m(2), left bundle-branch block, and left ventricular hypertrophy. Randomization to estrogen/progestin was not associated with heart failure (hazard ratio=1.0; 95% CI, 0.7 to 1.3). Diabetes was the strongest risk factor (adjusted hazard ratio=3.1; 95% CI, 2.3 to 4.2). Diabetic women with elevated body mass index or depressed creatinine clearance were at highest risk, with annual incidence rates of 7% and 13%, respectively. Among diabetic women, hyperglycemia was associated with heart failure risk (adjusted hazard ratio=3.0; 95% CI, 1.2 to 7.5 for fasting glucose>300 mg/dL compared with fasting glucose 80 to 150 mg/dL).Conclusions-We identified 9 predictors of heart failure in postmenopausal women with coronary disease. Diabetes was the strongest risk factor, particularly when poorly controlled or with concomitant renal insufficiency or obesity.