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IF 7.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation: Heart Failure Pub Date : 2025-03-03 DOI:10.1161/CIRCHEARTFAILURE.124.011598

Mingming Yang, Toru Kondo, Pooja Dewan, Akshay S Desai, Carolyn S P Lam, Martin P Lefkowitz, Milton Packer, Jean L Rouleau, Muthiah Vaduganathan, Michael R Zile, Pardeep S Jhund, Lars Køber, Scott D Solomon, John J V McMurray

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引用次数: 0

摘要

背景：对于射血分数轻度降低的心力衰竭/射血分数保留的心力衰竭患者，不同的合并症组合如何在患者层面和人群层面影响其风险尚不清楚。我们的目的是调查心血管和非心血管合并症不同组合（即多病症）的患病率以及患者和人群的相关死亡风险：利用TOPCAT试验（醛固酮拮抗剂治疗保留心功能的心力衰竭）和PARAGON-HF试验（ARNI与ARB在保留射血分数的心力衰竭中的总体疗效前瞻性比较）的患者水平数据，我们调查了5种最常见的心血管和非心血管合并症以及由此产生的45对合并症。我们使用 Cox 比例危险模型计算了全因死亡率的人口可归因比例以及每对合并症相互作用导致的相对超额风险：在 6504 名参与者中，95.2% 的人至少患有 10 种最常见合并症中的 2 种。患者风险最大的合并症是中风和外周动脉疾病（调整后危险比为 1.88 [95% CI, 1.27-2.79]），其次是外周动脉疾病和慢性阻塞性肺病（1.81 [95% CI, 1.31-2.51]），以及冠状动脉疾病和中风（1.67 [95% CI, 1.33-2.11]）。人群风险最高的是高血压和慢性肾脏病（CKD；调整后的人群可归因比例为 14.8% [95% CI，9.2%-19.9%]），其次是糖尿病和慢性肾脏病（13.3% [95% CI，10.6%-16.0%]），以及高血压和糖尿病（11.9% [95% CI，7.1%-16.5%]）。中风与冠心病（相互作用导致的相对超额风险为 0.61 [95% CI，0.13-1.09]）、糖尿病与慢性肾脏病（相互作用导致的相对超额风险为 0.46 [95% CI，-0.15-0.77]）以及肥胖与慢性肾脏病（相互作用导致的相对超额风险为 0.24 [95% CI，0.01-0.46]）这几对合并症存在协同相互作用（风险大于相加风险）：在射血分数轻度降低的心力衰竭/射血分数保留的心力衰竭患者和人群中，与合并症对相关的风险是不同的。在人群层面，高血压、慢性肾功能衰竭和糖尿病的风险最大，而在患者层面，多血管疾病和慢性阻塞性肺疾病的风险最大。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Impact of Multimorbidity on Mortality in Heart Failure With Mildly Reduced and Preserved Ejection Fraction.

Background: How different combinations of comorbidities influence risk at the patient level and population level in patients with heart failure with mildly reduced ejection fraction/heart failure with preserved ejection fraction is unknown. We aimed to investigate the prevalence of different combinations of cardiovascular and noncardiovascular comorbidities (ie, multimorbidity) and associated risk of death at the patient level and population level.

Methods: Using patient-level data from the TOPCAT trial (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) and PARAGON-HF trial (Prospective Comparison of ARNI With ARB Global Outcomes in HF With Preserved Ejection Fraction), we investigated the 5 most common cardiovascular and noncardiovascular comorbidities and the resultant 45 comorbidity pairs. Cox proportional hazard models were used to calculate the population-attributable fractions for all-cause mortality and the relative excess risk due to interaction for each comorbidity pair.

Results: Among 6504 participants, 95.2% had at least 2 of the 10 most prevalent comorbidities. The comorbidity pair with the greatest patient-level risk was stroke and peripheral artery disease (adjusted hazard ratio, 1.88 [95% CI, 1.27-2.79]), followed by peripheral artery disease and chronic obstructive pulmonary disease (1.81 [95% CI, 1.31-2.51]), and coronary artery disease and stroke (1.67 [95% CI, 1.33-2.11]). The pair with the highest population-level risk was hypertension and chronic kidney disease (CKD; adjusted population-attributable fraction, 14.8% [95% CI, 9.2%-19.9%]), followed by diabetes and CKD (13.3% [95% CI, 10.6%-16.0%]), and hypertension and diabetes (11.9% [95% CI, 7.1%-16.5%). A synergistic interaction (more than additive risk) was found for the comorbidity pairs of stroke and coronary artery disease (relative excess risk due to interaction, 0.61 [95% CI, 0.13-1.09]), diabetes and CKD (relative excess risk due to interaction, 0.46 [95% CI, -0.15 to 0.77]), and obesity and CKD (relative excess risk due to interaction, 0.24 [95% CI, 0.01-0.46]).

Conclusions: The risk associated with comorbidity pairs differs at the patient and population levels in heart failure with mildly reduced ejection fraction/heart failure with preserved ejection fraction. At the population level, hypertension, CKD, and diabetes account for the greatest risk, whereas at the patient level, polyvascular disease and chronic obstructive pulmonary disease are the most important.

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来源期刊

Circulation: Heart Failure 医学-心血管系统

CiteScore

12.90

自引率

3.10%

发文量

271

审稿时长

6-12 weeks

期刊介绍： Circulation: Heart Failure focuses on content related to heart failure, mechanical circulatory support, and heart transplant science and medicine. It considers studies conducted in humans or analyses of human data, as well as preclinical studies with direct clinical correlation or relevance. While primarily a clinical journal, it may publish novel basic and preclinical studies that significantly advance the field of heart failure.