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Povzetek: Background Polyvascular disease (PVD) is an increasingly recognised form of atherosclerotic cardiovascular disease (ASCVD) with heightened prognostic implications. This study aimed to comprehensively assess the prevalence, risk factors, and prognosis of PVD in Slovenia. Methods We conducted an observational retrospective cohort study using national-level reimbursement data from The Health Insurance Institute of Slovenia between January 1, 2015, and December 31, 2023. The study considered all adults who were hospitalised for coronary, cerebrovascular, or lower extremity peripheral arterial disease with diagnoses defined using ICD-10 codes. Multivariate logistic regression was used to identify cardiovascular risk factors for PVD. Patients were grouped by the number of affected vascular beds. The primary outcomes were all-cause death, major adverse cardiovascular events (MACE), major adverse limb events (MALE), and major bleeding. In outcome analysis, a landmark of 90 days was considered. Cause-specific survival analysis was performed, and associations with the primary outcomes was assessed using univariate and multivariate Cox proportional hazards models, adjusting for demographics, cardiovascular risk factors, comorbidities, and prescribed medication. Findings The study included 91,917 adults hospitalised for ASCVD. Of these, 85,703 (93.2%) had atherosclerosis in one vascular bed, 5878 (6.4%) in two, and 336 (0.4%) in three; the latter two groups (6214; 6.8%) were classified as having PVD. Traditional cardiovascular risk factors were strongly associated with PVD, with chronic kidney disease (odds ratio [OR] 1.96; 95% CI 1.81–2.11; p < 0.0001), diabetes (OR 1.57; 95% CI 1.48–1.66; p < 0.0001), and chronic obstructive pulmonary disease – a surrogate indicator of tobacco use (OR 1.56; 95% CI 1.40–1.74; p < 0.0001) emerging as the strongest predictors. Compared to patients with ASCVD in one vascular bed, patients with two affected beds had adjusted hazard ratios (HRs) of 1.24 (95% CI 1.09–1.42) for all-cause death, 1.51 (95% CI 1.24–1.83) for MACE, 2.52 (95% CI 2.08–3.05) for MALE, and 1.27 (95% CI 1.05–1.54) for major bleeding. Patients with three affected beds had adjusted HRs of 1.69 (95% CI 1.40–2.03), 2.70 (95% CI 2.23–3.28), 4.24 (95% CI 3.49–5.14), and 2.31 (95% CI 1.45–3.68), respectively. Interpretation Patients with PVD face a high overall disease burden, with adverse event rates increasing in proportion to the number of affected vascular beds. Accurate assessment of individual risk profiles is essential, as patients with the highest baseline risk are most likely to benefit from intensified preventive strategies. Potential underreporting inherent in administrative claims data, along with our selective criteria for defining leading diagnoses, may have somewhat limited the number of identified patients with PVD. Nonetheless, even after adjusting for group size, comorbidities, and prescribed medication, PVD independently predicted not only all-cause death and ischaemic events but also major bleeding. Further research is needed to define optimal treatment strategies in this high-risk population.
Ključne besede: atherosclerosis, polyvascular disease, peripheral arterial disease, risk factors, survival analysis
Objavljeno v DiRROS: 22.12.2025; Ogledov: 275; Prenosov: 183
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Povzetek: Background - Statin therapy is recommended for secondary prevention of atherosclerotic vascular disease (ASCVD) based on randomized trials, which enrolled mostly men with coronary artery disease (CAD), whereas women and patients with cerebrovascular (CVD) and peripheral artery disease (PAD) were under-represented. We analyzed the effectiveness of statin therapy uptake in a nation-wide cohort of women hospitalized for ASCVD. Methods - Women hospitalized for CAD, CVD, or PAD, including aortic disease, between 2015 and 2021 were retrospectively identified by linking the national hospital database, medicines reimbursement claims, and national mortality registry. The association of statin uptake within 30 days post-discharge with clinical outcomes (all-cause mortality and cardiovascular hospitalizations) was assessed by Kaplan-Meier curves and Cox proportional hazards regression model with propensity score-derived inverse probability of treatment weights and a 30-day landmark period. Results - We included 24,665 women with ASCVD – 14,419 with CAD, 5,427 with CVD, and 4,819 with PAD. Overall, the median age was 73 (64–81) years. The rates of statin uptake were 50% for women with CAD, 60% for CVD and 28% for PAD. Statin therapy uptake was associated with a reduction in all-cause mortality and cardiovascular hospitalizations across all three major types of ASCVD: hazard ratio (HR) 0.88, 95% confidence interval (CI) 0.83 – 0.93, p=0.001 for CAD, HR 0.87, 95% CI 0.80 – 0.94, p=0.006 for PAD, and HR 0.72, 95% CI 0.66 – 0.78, p<0.001 for CVD. Conclusion -Statin therapy is associated with reduced all-cause mortality and cardiovascular hospital readmissions in women with all major types of ASCVD.
Ključne besede: health, diseases, prevention
Objavljeno v DiRROS: 28.11.2025; Ogledov: 824; Prenosov: 152
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Povzetek: Background: Previous studies have suggested that the coronavirus disease 2019 (COVID-19) pandemic was associated with a decreased rate of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Data on how the COVID-19 pandemic has influenced mortality, seasonality of, and susceptibility to AECOPD in the chronic obstructive pulmonary disease (COPD) population is scarce. Methods: We conducted a national population-based retrospective study using data from the Health Insurance Institute of Slovenia from 2015 to February 2021, with 2015–2019 as the reference. We extracted patient and healthcare data for AECOPD, dividing AECOPD into severe, resulting in hospitalisation, and moderate, requiring outpatient care. The national COPD population was generated based on dispensed prescriptions of inhalation therapies, and moderate AECOPD events were analysed based on dispensed AECOPD medications. We extracted data on all-cause and non-COVID mortality. Results: The numbers of severe and moderate AECOPD were reduced by 48% and 34%, respectively, in 2020. In the pandemic year, the seasonality of AECOPD was reversed, with a 1.5-fold higher number of severe AECOPD in summer compared to winter. The proportion of frequent exacerbators (2 AECOPD hospitalisations per year) was reduced by 9% in 2020, with a 30% reduction in repeated severe AECOPD in frequent exacerbators and a 34% reduction in persistent frequent exacerbators (2 AECOPD hospitalisations per year for 2 consecutive years) from 2019. The risk of two or more moderate AECOPD decreased by 43% in 2020. In the multivariate model, pandemic year follow-up was the only independent factor associated with a decreased risk for severe AECOPD (hazard ratio [HR]: 0.71; 95% confidence interval [CI]: 0.61–0.84; p < 0.0001). In 2020, non-COVID mortality decreased (−15%) and no excessive mortality was observed in the COPD population. Conclusion: In the pandemic year, we found decreased susceptibility to AECOPD across severity spectrum of COPD, reversed seasonal distribution of severe AECOPD and decreased non-COVID mortality in the COPD population.
Ključne besede: chronic obstructive pulmonary disease -- mortality, pandemics, seasons, exacerbation, acute exacerbation, seasonal variations, population study
Objavljeno v DiRROS: 14.03.2022; Ogledov: 1788; Prenosov: 1089
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