The Incidence of Cardivascular Disease and Related Factors in Hemodialysis Patients
Date Issued
2015
Date
2015
Author(s)
Huang, Shing-Ju
Abstract
Background: Cardiovascular disease has a complex pathogenesis. For instance, individual genetic differences, bad lifestyle, moreover, the exposure to air pollution, are contributing to the risk of disease. In this study, we compare urban-rural discrepancy effect on hemodialysis patients to determine their risk factors and incidence rate of cardiovascular disease in this cohort. Perhaps, our main aim is to access the effect of Taiwan ambient air quality on cardiovascular disease risk in hemodialysis patients. Methods: In this study, we performed a prospective cohort analysis and studied whether individual characteristics, environmental factors act as effect modifiers. At the outset, we merge National Health Insurance data from ""Health and Welfare Statistics Application Center (HWSAC), Ministry of Health and Welfare"" and Taiwan EPA daily air pollution data (particles matters and PSI) to establish a database which string into subjects’ medical condition and EPA environment database. Following this, we try to identify urban and rural discrepancy, different dose of Statin drugs usage, and evaluation of population cardiovascular risk. Result: 4,885 hemodialysis patients from a 2000 year cohort are our main study group (0.24% respect to 200 million populations), male 2553 people (52.26%) and female 2332 people (47.74%). There is more than 80% dialysis patients’ age over 55 years old. However, our cohort subjects had very high mortality rate, which up to 88.6% from 2001 to 2011. Acute Myocardial Infraction incidence density was 0.57%~1.43%, Ischemia Heart Disease incidence density was 5.98% ~7.41 %. Air pollution had dramatically changes in Taiwan over the past 10 years. Especial, the central area, the Southwestern area and the southern area (Kaohsiung-Pingtung) has the largest variation. Approximately 30% variation in particles matters concentration for the past decade, particularly, the particular matter concentration variance of eastern area hit up to 75%. About PSI level, we find out Kaohsiung and Pingtung areas have the highest PSI concentration in ambient air of Taiwan. For the multivariate analysis of dialysis patients’ individual risk factors, ""Sex"", ""Age"", ""diabetes"", ""hypertension"", ""comorbidity"" are the risk factors of the cardiovascular diseases. After adjusting for the risk of acute myocardial infarction incidence, hemodialysis patient with diabetes, their risk is 3.26 times then without diabetes (OR: 3.26, 95% CI: 1.58 ~ 6.69). For ischemic heart disease, ""sex"" (OR : 1.19, 95% CI: 1.04 ~ 1.36), ""ages of 55 to 64 years"" (OR: 2.76, 95% CI: 2.18 ~ 3.48); ""Age elder than 65 years"" (OR: 3.09, 95% CI: 2.45 ~ 3.89) , ""diabetes"" (OR: 1.36, 95% CI: 1.15 ~ 1.59), ""high blood pressure"" (OR: 1.16, 95% CI: 1.61 ~ 1.33) and ""comorbidity"" (OR: 1.51, 95% CI: 1.32 ~ 1.71) were independent predictors. However, when adding air pollution factors, the influence of air pollution didn’t show the statistical significance. In contrast, individual variables, such as sex, age, comorbidity, are the significant risk factors. For acute myocardial infarction, the results of multivariate analysis is similar to previous one. Environmental risk factors in hemodialysis patients were not significant, only ""age"" variable is significant risk factor. Conclusions: According to our result, we found that the risk of elderly hemodialysis patients’ myocardial infarction or ischemic cardiovascular diseases incidence is higher than middle-aged patients. Older people, presence of diabetes contribute to increase risk of cardiovascular disease in the present cohort. Although air pollution have risk for cardiovascular disease, but this study found that personal factors play more weight than the impact of environmental factors. We suggest that future research can put more emphasis on the accumulation of air pollution. For example, consider subject residential location’s cumulative air pollution concentration one year before disease onset, which may explain the impact of environmental factors.
Subjects
Hemodialysis
Cardiovascular Disease
Urban Rural discrepancy
Statin
Type
thesis
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