先天性心脏病幸存者的心血管疾病危险因素与心力衰竭相关。
Cardiovascular disease risk factors in congenital heart disease survivors are associated with heart failure.
作者信息
Landstrom Andrew P, Spears Tracy, D'Ottavio Alfred, Chiswell Karen, Sommerhalter Kristin, Soim Aida, Farr Sherry L, Crume Tessa, Book Wendy M, Whitehead Kevin, Botto Lorenzo D, Li Jennifer S, Hsu Daphne T
机构信息
Duke Department of Pediatrics, Division of Cardiology, Duke University School of Medicine, Durham, NC, USA.
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
出版信息
Pediatr Res. 2025 Feb;97(2):700-706. doi: 10.1038/s41390-024-03352-8. Epub 2024 Jul 5.
BACKGROUND
Despite advances in treatment and survival, individuals with congenital heart defects (CHD) have a higher risk of heart failure (HF) compared to the general population.
OBJECTIVE
To evaluate comorbidities associated with HF in patients with CHD with a goal of identifying potentially modifiable risk factors that may reduce HF-associated morbidity and mortality.
METHODS
Five surveillance sites in the United States linked population-based healthcare data and vital records. Individuals with an ICD-9-CM code for CHD aged 11-64 years were included and were stratified by presence of HF diagnosis code. Prevalence of death and cardiovascular risk factors based on diagnosis codes were compared by HF status using log-linear regression.
RESULTS
A total of 25,343 individuals met inclusion/exclusion criteria. HF was documented for 2.2% of adolescents and 12.9% of adults with CHD. Adolescents and adults with HF had a higher mortality than those without HF. In both age groups, HF was positively associated with coronary artery disease, hypertension, obesity, diabetes, and increased healthcare utilization compared to those without HF.
CONCLUSIONS
Within this population-based cohort, over 1 in 50 adolescents and 1 in 8 adults with CHD had HF, which was associated with increased mortality. Modifiable cardiovascular comorbidities were associated with HF.
IMPACT
Five sites in the United States linked population-based healthcare data and vital records to establish surveillance network for identifying the factors which influence congenital heart disease (CHD) outcomes. Survivors of CHD frequently develop heart failure across the lifespan. Over 1 in 50 adolescent and 1 in 8 adult survivors of CHD have heart failure which is associated with increased mortality compared to CHD survivors without heart failure. Heart failure development is associated with potentially modifiable cardiovascular risk factors such as hypertension, coronary artery disease, and diabetes. Controlling modifiable cardiovascular risk factors may serve to lower the risk of heart failure and mortality in survivors of congenital heart disease of all ages.
背景
尽管在治疗和生存率方面取得了进展，但与普通人群相比，先天性心脏病（CHD）患者发生心力衰竭（HF）的风险更高。
目的
评估CHD患者中与HF相关的合并症，以确定可能降低HF相关发病率和死亡率的潜在可改变风险因素。
方法
美国的五个监测点将基于人群的医疗保健数据与生命记录相链接。纳入年龄在11 - 64岁、具有CHD的ICD - 9 - CM编码的个体，并根据是否存在HF诊断编码进行分层。使用对数线性回归按HF状态比较基于诊断编码的死亡和心血管危险因素的患病率。
结果
共有25343名个体符合纳入/排除标准。记录显示，患有CHD的青少年中有2.2%、成年人中有12.9%发生HF。患有HF的青少年和成年人的死亡率高于未患HF者。在两个年龄组中，与未患HF者相比，HF与冠状动脉疾病、高血压、肥胖、糖尿病以及医疗保健利用率增加呈正相关。
结论
在这个基于人群的队列中，超过五十分之一的患有CHD的青少年和八分之一的患有CHD的成年人患有HF，这与死亡率增加相关。可改变的心血管合并症与HF相关。
影响
美国的五个监测点将基于人群的医疗保健数据与生命记录相链接，以建立监测网络，用于识别影响先天性心脏病（CHD）结局的因素。CHD幸存者在其一生中经常发生心力衰竭。超过五十分之一的患有CHD的青少年幸存者和八分之一的患有CHD的成年幸存者患有心力衰竭，与没有心力衰竭的CHD幸存者相比，这与死亡率增加相关。心力衰竭的发生与潜在可改变的心血管危险因素如高血压、冠状动脉疾病和糖尿病相关。控制可改变的心血管危险因素可能有助于降低各年龄段先天性心脏病幸存者发生心力衰竭和死亡的风险。
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