| アブストラクト | CONTEXT: Mortality studies have established that cardiovascular disease is the leading cause of death in patients with adrenal insufficiency and the risk is greater than that observed in individually matched controls. OBJECTIVE: Here we have performed a detailed analysis of cardiovascular morbidity and mortality, taking account of the role of comorbidities. METHODS: We performed a retrospective cohort study using the Clinical Practice Research Datalink (CPRD), a UK general practitioner database. The participant population comprised 6821 patients with adrenal insufficiency (primary, 2052; secondary, 3948) compared with 67 564 individually matched controls, with and without adjustment for comorbidities (diabetes, hypertension, dyslipidemia, previous cardiovascular disease, and smoking). The main outcome measures were composite cardiovascular events recorded in the CPRD and cardiovascular mortality in participants with linked national mortality data. RESULTS: Hazard ratios (95% CI) for composite cardiovascular events in patients with adrenal insufficiency of any cause were 1.28 (1.20-1.36, unadjusted) and 1.07 (1.01-1.14, adjusted). Increased cerebrovascular events in patients with secondary adrenal insufficiency accounted for most of the increased hazard (1.53 [1.34-1.74, adjusted]) and were associated with cranial irradiation therapy. Cardiovascular mortality data were available for 3547 patients and 34 944 controls. The adjusted hazard ratio for ischemic heart disease mortality was 1.86 (1.25-2.78) for primary adrenal insufficiency and 1.39 (1.02-1.89) for secondary. CONCLUSION: Comorbidities largely accounted for the increased cardiovascular events but in secondary adrenal insufficiency, cerebrovascular events were independently increased and associated with irradiation treatment. However, the risk of cardiovascular mortality remained increased even following adjustment for comorbidities in both primary and secondary adrenal insufficiency. |
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| 投稿日 | 2021/2/16 |
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| 投稿者 | Ngaosuwan, Kanchana; Johnston, Desmond G; Godsland, Ian F; Cox, Jeremy; Majeed, Azeem; Quint, Jennifer K; Oliver, Nick; Robinson, Stephen |
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| ジャーナル名 | The Journal of clinical endocrinology and metabolism |
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| 組織名 | Department of Metabolism, Digestion and Reproduction, Faculty of Medicine,;Imperial College London, London, UK.;Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical;Science, Chulabhorn Royal Academy, Bangkok, Thailand.;Department of Metabolic Medicine, St. Mary's Hospital, Imperial College NHS;trust, London, UK.;Department of Primary Care & Public Health, School of Public Health, Imperial;College London, London, UK.;National Heart and Lung Institute, Imperial College London, London, UK. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/33585930/ |
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