Marital status shows a strong protective effect on long-term mortality among first acute myocardial infarction-survivors with diagnosed hyperlipidemia - findings from the MONICA/KORA myocardial infarction registry
Marital status shows a strong protective effect on long-term mortality among first acute myocardial infarction-survivors with diagnosed hyperlipidemia - findings from the MONICA/KORA myocardial infarction registry
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DOI：
10.1186/1471-2458-14-98
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发表时间：
2014-01-30
影响因子：
4.5
通讯作者：
Meisinger, Christa
中科院分区：
文献类型：
--
作者：
Quinones, Philip Andrew;Kirchberger, Inge;Meisinger, Christa
背景：通过婚姻状况降低长期死亡率在普通人群中得到了很好的证实。然而，效果已被证明随着时间的推移而变化，并因死亡原因而有很大不同。这项研究考察了婚姻状况对首次急性心肌梗死后长期死亡率的影响。方法：数据来自基于人群的MONICA(心血管疾病监测趋势和决定因素)/KORA(奥格斯堡地区合作卫生研究)-心肌梗死登记，评估来自德国巴伐利亚州南部奥格斯堡市和两个邻近地区的病例。共有3766名年龄在28岁至74岁之间的男性和女性在首次心肌梗死后28天内存活。结果：研究对象包括2,854名(75.8%)已婚人士。在中位数5.3年的随访期间，四分位数的范围从3.3到7.6年，533例(14.15%)死亡。在已婚和未婚人群中，分别有388例(13.6%)和145例(15.9%)死亡。总体婚姻状况显示保护性HR为0.76(95%可信区间为0.47-1.22)。分层分析显示，只有在60岁以下被诊断为高脂血症的男性和女性中才有很强的保护作用。两年生存率为0.27(95%可信区间0.13~0.59)，10年生存率为0.43(95%可信区间0.27~0.68)。用同居状态替代婚姻状况证实了阶层特异性效应[HR：0.52(95%CI 0.31~0.86)]。结论：婚姻状况对确诊为高脂血症的首次心肌梗死存活者具有较强的保护作用，这种保护作用随着年龄的增长而减弱。治疗、建议的生活方式改变或其他特定于高脂血症的特征可能是潜在的因素，由配偶的社会支持介导。潜在的原因应该在进一步的研究中加以研究。
Background: Reduction of long term mortality by marital status is well established in general populations. However, effects have been shown to change over time and differ considerably by cause of death. This study examined the effects of marital status on long term mortality after the first acute myocardial infarction.Methods: Data were retrieved from the population-based MONICA (Monitoring trends and determinants on cardiovascular diseases)/KORA (Cooperative Health Research in the Region of Augsburg)-myocardial infarction registry which assesses cases from the city of Augsburg and 2 adjacent districts located in southern Bavaria, Germany. A total of 3,766 men and women aged 28 to 74 years who were alive 28 days after their first myocardial infarction were included. Hazard ratios (HR) for the effects of marital status on mortality after one to 10 years of follow-up are presented.Results: The study population included 2,854 (75.8%) married individuals. During a median follow-up of 5.3 years, with an inter-quartile range of 3.3 to 7.6 years, 533 (14.15%) deaths occurred. Among married and unmarried individuals 388 (13.6%) and 145 (15.9%) deaths occurred, respectively. Overall marital status showed an insignificant protective HR of 0.76 (95% confidence interval (CI) 0.47-1.22). Stratified analyses revealed strong protective effects only among men and women younger than 60 who were diagnosed with hyperlipidemia. HRs ranged from 0.27 (95% CI 0.13-0.59) for a two-year survival to 0.43 (95% CI 0.27-0.68) for a 10-year survival. Substitution of marital status with co-habitation status confirmed the strata-specific effect [HR: 0.52 (95% CI 0.31-0.86)].Conclusions: Marital status has a strong protective effect among first myocardial infarction survivors with diagnosed hyperlipidemia, which diminishes with increasing age. Treatments, recommended lifestyle changes or other attributes specific to hyperlipidema may be underlying factors, mediated by the social support of spouses. Underlying causes should be examined in further studies.