Background and Aims Patients with kidney failure have a higher risk of cardiovascular disease compared with the general population. Whilst temporal trends of myocardial infarction and stroke are declining in the general population, these have not been evaluated in patients with kidney failure. This study aimed to describe national trends in the incidence, treatment, and outcomes of myocardial infarction and stroke in patients with kidney failure (i.e. on dialysis or with a kidney transplant) over a 20-year period, stratified by age and sex. Methods In this retrospective national data linkage study, all patients with kidney failure in Scotland (UK) receiving kidney replacement therapy between January 1996 and December 2016 were linked to national hospitalization, prescribing, and death records. The primary outcomes were the incidence of myocardial infarction and stroke, and subsequent cardiovascular death. Generalized additive models were constructed to estimate age-standardized, sex-stratified incidence rates and trends in cardiovascular and all-cause death. Results Amongst 16 050 patients with kidney failure [52 (SD 15) years; 41.5% women], there were 1992 [66 (SD 12) years; 34.8% women] and 996 [65 (SD 13) years; 45.1% women] incident myocardial infarctions and strokes, respectively, between January 1996 and December 2016. During this period, the age-standardized incidence of myocardial infarction per 100 000 decreased in men {from 4376 [95% confidence interval (CI) 3998–4785] to 1835 (95% CI 1692–1988)} and women [from 3268 (95% CI 2982–3593) to 1369 (95% CI 1257–1491)]. Similarly, the age-standardized incidence of stroke per 100 000 also decreased in men [from 1978 (95% CI 1795–2175) to 799 (95% CI 729–875)] and women [from 2234 (95% CI 2031–2468) to 903 (95% CI 824–990)]. Compared with the general population, the incidence of myocardial infarction was four- to eight-fold higher in patients with kidney failure, whilst for stroke it was two- to four-fold higher. The use of evidence-based cardioprotective treatment increased over the study period, and the predicted probability of cardiovascular death within 1 year of myocardial infarction for a 66-year-old patient with kidney failure (mean age of the cohort) fell in men (76.6% to 38.6%) and women (76.8% to 38.8%), and also decreased in both sexes following stroke (men, from 63.5% to 41.4%; women, from 67.6% to 45.8%). Conclusions The incidence of myocardial infarction and stroke has halved in patients with kidney failure over the past 20 years but remains significantly higher than in the general population. Despite improvements in treatment and outcomes, the prognosis of these patients following myocardial infarction and stroke remains poor.

中文翻译：

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肾脏替代疗法：苏格兰全国研究中心肌梗塞和中风的发病率、治疗和结果的趋势

背景和目的 与一般人群相比，肾衰竭患者患心血管疾病的风险更高。虽然一般人群中心肌梗死和中风的时间趋势正在下降，但尚未在肾衰竭患者中进行评估。本研究旨在描述 20 年来肾衰竭（即透析或肾移植）患者心肌梗死和中风的发病率、治疗和结果的全国趋势，按年龄和性别分层。方法 在这项回顾性国家数据关联研究中，苏格兰（英国）所有在 1996 年 1 月至 2016 年 12 月期间接受肾脏替代治疗的肾衰竭患者均与全国住院、处方和死亡记录相关联。主要结局是心肌梗塞和中风的发生率以及随后的心血管死亡。构建广义相加模型来估计年龄标准化、性别分层的发病率以及心血管和全因死亡的趋势。结果 16 050 名肾衰竭患者 [52 (SD 15) 岁；41.5%女性]，有1992[66（SD 12）年；34.8% 女性] 和 996 [65 (SD 13) 岁；1996 年 1 月至 2016 年 12 月期间，分别有 45.1% 的女性]发生心肌梗死和中风。在此期间，男性每 10 万人中年龄标准化的心肌梗死发病率下降{从 4376 [95% 置信区间 (CI) 3998– 4785]到1835 (95% CI 1692–1988)}和女性[从3268 (95% CI 2982–3593)到1369 (95% CI 1257–1491)]。同样，男性每 10 万人中的年龄标准化卒中发病率也有所下降 [从 1978 年 (95% CI 1795–2175) 降至 799 (95% CI 729–875)] 和女性 [从 2234 (95% CI 2031–2468)] ) 至 903 (95% CI 824–990)]。与一般人群相比，肾衰竭患者心肌梗死的发生率高出四到八倍，而中风的发生率高出两到四倍。在研究期间，基于证据的心脏保护治疗的使用有所增加，对于一名 66 岁肾衰竭患者（队列的平均年龄），男性心肌梗塞 1 年内心血管死亡的预测概率下降（76.6 % 降至 38.6%）和女性（76.8% 降至 38.8%），而且中风后两性均有所下降（男性从 63.5% 降至 41.4%；女性从 67.6% 降至 45.8%）。结论 过去 20 年来，肾衰竭患者的心肌梗死和中风发病率减少了一半，但仍显着高于普通人群。尽管治疗和结果有所改善，但这些心肌梗死和中风患者的预后仍然很差。