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. 2024 Jun 15;29(1):330.
doi: 10.1186/s40001-024-01929-x.

Ischemic cardio-cerebrovascular disease and all-cause mortality in Chinese elderly patients: a propensity-score matching study

Affiliations

Ischemic cardio-cerebrovascular disease and all-cause mortality in Chinese elderly patients: a propensity-score matching study

Qian Yang et al. Eur J Med Res. .

Abstract

Background: Ischemic cardio-cerebrovascular disease is the leading cause of mortality worldwide. However, studies focusing on elderly and very elderly patients are scarce. Hence, our study aimed to characterize and investigate the long-term prognostic implications of ischemic cardio-cerebrovascular diseases in elderly Chinese patients.

Methods: This retrospective cohort study included 1026 patients aged ≥ 65 years who were categorized into the mono ischemic cardio-cerebrovascular disease (MICCD) (either coronary artery disease or ischemic stroke/transient ischemic attack) (n = 912) and the comorbidity of ischemic cardio-cerebrovascular disease (CICCD) (diagnosed with both coronary artery disease and ischemic stroke/transient ischemic attack at admission) (n = 114). The primary outcome was all-cause death. The mortality risk was evaluated using the Cox proportional hazards risk model with multiple adjustments by conventional and propensity-score-based approaches.

Results: Of the 2494 consecutive elderly patients admitted to the hospital, 1026 (median age 83 years [interquartile range]: 76.5-86.4; 94.4% men) met the inclusion criteria. Patients with CICCD consisted mostly of very elderly (79.2% vs. 66.1%, P < 0.001) individuals with a higher burden of comorbidities. Over a median follow-up of 10.4 years, 398 (38.8%) all-cause deaths were identified. Compared with the MICCD group, the CICCD group exhibited a higher adjusted hazard ratio (HR) (95% confidential interval, CI) of 1.71 (1.32-2.39) for long-term mortality after adjusting for potential confounders. The sensitivity analysis results remained robust. After inverse probability of treatment weighting (IPTW) modeling, the CICCD group displayed an even worse mortality risk (IPTW-adjusted HR: 2.07; 95% CI 1.47-2.90). In addition, anemia (adjusted HR: 1.48; 95% CI 1.16-1.89) and malnutrition (adjusted HR: 1.43; 95% CI 1.15-1.78) are also independent risk factors for all-cause mortality among elderly and very elderly patients.

Conclusions: Our results thus suggest that elderly patients with ischemic cardio-cerebrovascular disease and anemia or malnutrition may have higher mortality, which may be predicted upon admission. These findings, however, warrant further investigation.

Keywords: Cohort study; Ischemic cardio-cerebrovascular disease; Mortality risk; Poly-vascular disease.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Eligibility of the study patients. The flowchart of the eligibility of 1026 patients is included in the long-term mortality analysis
Fig. 2
Fig. 2
Kaplan–Meier curve for all-cause mortality between groups before and after PSM. A All-cause mortality before PSM. B All-cause mortality after PSM. MICCD, Mono ischemic cardio-cerebrovascular disease; CICCD, Comorbidity of ischemic cardio-cerebrovascular disease; PSM, Propensity-score matching
Fig. 3
Fig. 3
Subgroup analyses. Subgroup analyses for the adjusted HR (95% CI) of ischemic cardio-cerebrovascular disease groups for long-term mortality by age, BMI, smoking, hemoglobin, CRP, albumin, TG, LDL, eGFR, hypertension, aspirin, ADP receptor inhibitors, statins, and CCB. BMI, body mass index; CCB, calcium channel blocker; MICCD, Mono ischemic cardio-cerebrovascular disease; CI, confidence interval; CRP,  C-reactive protein; eGFR, estimated glomerular filtration rate; HR, hazard ratio; LDL, low-density lipoprotein; TG, triglycerides
Fig. 4
Fig. 4
Graphical abstract. Left: A brief flowchart summary of this study. Right: Main results of this study. CICCD,  Comorbidity of ischemic cardio-cerebrovascular disease; MICCD,  Mono ischemic cardio-cerebrovascular disease

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