背景:在大量动脉粥样硬化性心血管疾病(ASCVD)患者中,肌腱断裂和肌腱病(TRT)的患病率尚未确定。我们调查了ASCVD患者和普通人群中的TRT患病率,使用SymphonyHealthIntegratedDataverse的数据,美国大型医疗和药房索赔数据库。
方法:本回顾性研究,观察性研究纳入了鉴定期间(2019年1月至2020年12月)和连续纳入12个月的索赔数据库中年龄≥19岁的患者.主要结果是指标日期后12个月内TRT的证据(ASCVD队列中首次诊断为ASCVD;在整个人群中的索赔数据库中首次提出索赔)。诊断代码(ICD-10和/或CPT)用于定义ASCVD和TRT诊断。
结果:ASCVD队列和总体人群包括5,589,273和61,715,843名患者,分别。在ASCVD队列中,在67.9%(他汀类药物)中确定使用与TRT有潜在或已知关联的药物,17.7%(皮质类固醇),和16.7%(氟喹诺酮类药物)的患者。据报道,1556例患者使用了Bempedoic酸(<0.1%)。12个月随访期间TRT患病率分别为3.4%(ASCVD队列)和1.9%(总体人群)。在ASCVD患者中,83.5%的患者仅在身体的一个区域经历了TRT。ASCVD队列中与TRT最相关的因素是年龄增加,最值得注意的是在45-64岁的人群中(优势比[OR]2.19;95%置信区间[CI]2.07-2.32),肥胖(OR1.51;95%CI1.50-1.53),和类风湿性关节炎(OR1.47;95%CI1.45-1.79)。使用他汀类药物或bempedoic酸与TRT风险增加无关。
结论:ASCVD患者可能比一般人群有更大的TRT风险,这可能是由于合并症的患病率增加以及与TRT潜在或已知关联的药物的使用所致。
动脉粥样硬化患者,心脏病发作的主要原因,笔画,和外周血管疾病,通常需要几种药物来控制疾病。一些用于治疗动脉粥样硬化的药物与肌腱撕裂(或破裂)或肌腱肿胀/炎症(肌腱病)的较高发生率有关。然而,这些患者中可能存在其他与这些药物无关的增加肌腱损伤风险的因素.这项研究使用了550多万动脉粥样硬化患者和6300多万反映美国普通人群的医疗记录来确定肌腱损伤的患病率。此外,研究人员研究了可能与每组肌腱损伤风险较高相关的其他因素。在12个月的时间里,肌腱损伤发生在动脉粥样硬化患者的3.4%和一般人群中的1.8%。在动脉粥样硬化患者中,肥胖等因素,年龄较大(45-64岁),或患有类风湿性关节炎也与肌腱损伤的风险增加有关。他汀类药物或bempedoic酸的使用与肌腱损伤之间没有关联。这些结果可能有助于医疗保健提供者确定肌腱损伤的潜在风险并指导该患者人群的治疗。
BACKGROUND: The prevalence of tendon rupture and tendinopathies (TRT) has not been determined in a large population of patients with atherosclerotic cardiovascular disease (ASCVD). We investigated TRT prevalence among patients with ASCVD and in the general population, using data from the Symphony Health Integrated Dataverse, a large US medical and pharmacy claims database.
METHODS: This retrospective, observational study included patients aged ≥ 19 years from the claims database during the identification period (January 2019 to December 2020) and 12 months of continuous enrollment. The primary outcome was evidence of TRT in the 12 months following the index date (first ASCVD diagnosis in the ASCVD cohort; first claim in the claims database in the overall population). Diagnostic codes (ICD-10 and/or CPT) were used to define ASCVD and TRT diagnosis.
RESULTS: The ASCVD cohort and overall population included 5,589,273 and 61,715,843 patients, respectively. In the ASCVD cohort, use of medications with a potential or known association with TRT was identified in 67.9% (statins), 17.7% (corticosteroids), and 16.7% (fluoroquinolones) of patients. Bempedoic acid use was reported in 1556 (< 0.1%) patients. TRT prevalence during 12-month follow-up was 3.4% (ASCVD cohort) and 1.9% (overall population). Among patients with ASCVD, 83.5% experienced TRT in only one region of the body. Factors most associated with TRT in the ASCVD cohort were increasing age, most notably in those aged 45-64 years (odds ratio [OR] 2.19; 95% confidence interval [CI] 2.07-2.32), obesity (OR 1.51; 95% CI 1.50-1.53), and rheumatoid arthritis (OR 1.47; 95% CI 1.45-1.79). Use of statins or bempedoic acid was not associated with increased TRT risk.
CONCLUSIONS: Patients with ASCVD may have greater risk of TRT than the general population, which may be driven by an increased prevalence of comorbidities and use of medications with a potential or known association with TRT.
Patients with atherosclerosis, the main cause of heart attacks, strokes, and peripheral vascular disease, typically require several drugs to control the disease. Some of the drugs used to treat atherosclerosis have been linked to a higher occurrence of tendon tears (or ruptures) or swelling/inflammation of the tendons (tendinopathies). However, there may be other factors present in these patients that increase the risk of tendon injuries that are not related to these drugs. This study used the medical records of over 5.5 million patients with atherosclerosis and over 63 million patients reflecting the general population in the United States to determine the prevalence of tendon injury. Additionally, the researchers looked at other factors that might be related to a higher risk of tendon injury in each group. Over a 12-month period, tendon injuries occurred in 3.4% of patients with atherosclerosis and 1.8% of patients in the general population. In patients with atherosclerosis, factors such as being obese, older (45–64 years), or having rheumatoid arthritis were also linked to an increased risk of tendon injuries. There was no association seen between statin or bempedoic acid use and tendon injuries. These results may help healthcare providers to determine the underlying risk of tendon injuries and guide treatment of this patient population.