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低尿素水平的种族差异:对心力衰竭临床试验的影响
Apoorva Gangavelli1, Zihao Liu2, Jeffrey Wang1
1Division of Cardiology, Emory University School of Medicine, Atlanta, GA.
American heart journal
|June 21, 2023
概括
几乎10%的心力衰竭患者的内尿素水平较低. 在临床试验中更严格的BNP切断线不成比例地排除了黑人患者,影响了心力衰竭研究中的多样性.
科学领域:
- 心脏病学 心脏病学
- 临床试验 临床试验
- 健康差异 在健康上的差异
背景情况:
- 一些心力衰竭 (HF) 患者表现出低尿酸 (NP) 水平,这引发了关于他们被排除在临床试验之外的问题.
- 了解与低NP水平相关的因素对于确保在HF研究中得到公平代表至关重要.
研究的目的:
- 确定与住院HF患者意外低B型性尿素 (BNP) 水平相关的因素.
- 评估NP纳入标准在模拟HF随机临床试验 (RCT) 中对种族多样性的影响.
主要方法:
- 对31,704名住院HF患者与BNP测量 (2010-2020) 的回顾性分析.
- 多变量逻辑回归用于识别与低BNP (<50 pg/mL) 相关的因素.
- 使用不同的BNP值和已确定的纳入/排除标准,模拟HFRCT的资格.
主要成果:
- 8.9%的队列有意想不到的低BNP水平.
- 与低BNP相关的因素包括保留射出分数 (HFpEF) 的HF,肥胖,黑人种族和男性性别.
- 与非黑人患者相比,模拟RCT标准,特别是较高的BNP值,不成比例地排除了黑人患者.
结论:
- 医院住院的HF患者中,有很大一部分患有低BNP水平.
- 目前对HF试验的基于NP的纳入标准可能会为黑人患者的参与创造障碍,可能会限制研究结果的概括性.
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