Int J Cardiol 2011 Oct; [IF:6.802]
Gender difference in cardiovascular risk factors in the elderly with cardiovascular disease in the last stage of lifespan: The PROTEGER study.
Zhang Y , Agnoletti D , Iaria P , Protogerou AD , Safar ME , Xu Y , Blacher J .
Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
上海同济大学医药学院，上海第十人民医院心内科
Abstract
BACKGROUND: It is known that the prognostic value of cardiovascular risk factors differed between men and women, but data in the elderly are very limited. METHODS: We assessed cardiovascular structural and functional measurements (intima-media thickness, pulse pressure, pulse wave velocity, left atrial dimension (LAD), arrhythmia, deceleration time of transmitral early diastolic flow and left ventricular ejection fraction (LVEF)), by ultrasonography, blood pressure monitor, electrocardiography and applanation tonometry, as well as conventional cardiovascular risk factors (age, body mass index, smoke, total to high density lipoprotein (HDL) cholesterol ratio, and plasma glucose), and investigated their associations with all-cause mortality in men and women, separately, in 331 consecutive patients (87±7years, 74.0% female) with a history of cardiovascular disease from the geriatric departments. After a mean follow-up of 378days, 110 deaths were recorded. RESULTS: In the full adjusted models, we found that increased LAD (hazard ratio [HR]=2.24 per 1-standard deviation [SD]; 95% confidential interval [CI]: 1.23-4.09), reduced LVEF (HR=0.60 per 1-SD; 95% CI: 0.38-0.96), and increased total-to-HDL cholesterol ratio (HR=1.99 per 1-SD; 95% CI: 1.05-3.78) were significant predictors of all-cause mortality in men, whereas the presence of arrhythmia (HR=2.47; 95% CI: 1.28-4.78), increased plasma glucose (HR=1.32 per 1-SD; 95% CI: 1.06-1.64) and decreased body mass index (HR=0.60 per 1-SD; 95% CI: 0.44-0.83) could significantly predict all-cause mortality in women. CONCLUSIONS: Even in the last stage of lifespan, risk factors for all-cause death still differ significantly in men and women with cardiovascular disease.
摘要
背景：众所周知，心血管疾病的危险因素在男性和女性之间的预测价值是不同的，但是在老年人中数据非常有限。
方法：我们通过超声检查，血压监测仪，心电图和平面压力波测定的方法，来评估心血管结构和功能的测量（内膜中层厚度，脉压，脉搏波速度，左心房大小（LAD），心律失常，舒张早期跨二尖瓣血流的减速时间和左心室射血分数（LVEF）），和传统的心血管危险因素（年龄，体重指数，吸烟，总胆固醇对高密度脂蛋白胆固醇（HDL）的比例，以及血浆葡萄糖），并研究它们与男性和女性的全因死亡率之间的关联，另外，由老年部门提供的331例有心血管疾病病史的连续病例（87±7岁，74%为女性）中，在平均随访378日之后，有110例死亡记录。
结果：在充分调整的模型中，我们发现，升高的LAD（每增加一个标准差[SD]，风险比[HR] 增加2.24；95%可信区间[CI]：1.23-4.09），降低的LVEF(HR=0.60 ; 95% CI: 0.38-0.96)），和升高的总胆固醇对高密度胆固醇比率（HR=1.99；95%CI：1.05-3.78）在男性的全因死亡中为重要预测因素，而存在心律失常（HR=2.47；95%CI：1.28-4.78），升高的血浆葡萄糖（HR=1.32；95%CI：1.06-1.64）和降低的体重指数（HR=0.60；95%CI：0.44-0.83），可以显著地预测女性的全因死亡。
结论：即使是在生命的最后阶段，在有心血管疾病病史的男性和女性中，全因死亡的危险因子仍然是有显著的不同之处的。
