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[大学生论坛]:2型糖尿病患者的危险因素,死亡率和心血管结局

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Vaness-A 发表于 2019-1-4 10:38:14 | 显示全部楼层 |阅读模式
Risk Factors, Mortality, and Cardiovascular Outcomes in Patients with Type 2 Diabetes
2型糖尿病患者的危险因素,死亡率和心血管结局
Abstract
摘要
BACKGROUND
背景
Patients with diabetes are at higher risk for death and cardiovascular outcomes than the general population. We investigated whether the excess risk of death and cardiovascular events among patients with type 2 diabetes could be reduced or eliminated.
与一般人群相比,糖尿病患者死亡和心血管结局的风险更高。我们研究了是否可以减少或消除2型糖尿病患者的死亡和患心血管疾病的过高风险。

METHODS
方法
In a cohort study, we included 271,174 patients with type 2 diabetes who were registered in the Swedish National Diabetes Register and matched them with 1,355,870 controls on the basis of age, sex, and county. We assessed patients with diabetes according to age categories and according to the presence of five risk factors (elevated glycated hemoglobin level, elevated low-density lipoprotein cholesterol level, albuminuria, smoking, and elevated blood pressure). Cox regression was used to study the excess risk of outcomes (death, acute myocardial infarction, stroke, and hospitalization for heart failure) associated with smoking and the number of variables outside target ranges. We also examined the relationship between various risk factors and cardiovascular outcomes.
在一项队列研究中,我们纳入了271,174名在瑞典国家糖尿病登记处登记过的患有2型糖尿病的患者,我们根据年龄、性别和县将这些患者与1,355,870名对照者进行匹配。 我们根据年龄类别及五种危险因素(糖化血红蛋白水平升高,低密度脂蛋白胆固醇水平升高,白蛋白尿,吸烟和血压升高)评估糖尿病患者。Cox回归用于研究其与吸烟相关的结果(死亡,急性心肌梗死,中风和心力衰竭住院)的超额风险以及目标范围之外的变量数量。我们还研究了各种危险因素与心血管结局之间的关系。

RESULTS
结果
The median follow-up among all the study participants was 5.7 years, during which 175,345 deaths occurred. Among patients with type 2 diabetes, the excess risk of outcomes decreased stepwise for each risk-factor variable within the target range. Among patients with diabetes who had all five variables within target ranges, the hazard ratio for death from any cause, as compared with controls, was 1.06 (95% confidence interval [CI], 1.00 to 1.12), the hazard ratio for acute myocardial infarction was 0.84 (95% CI, 0.75 to 0.93), and the hazard ratio for stroke was 0.95 (95% CI, 0.84 to 1.07). The risk of hospitalization for heart failure was consistently higher among patients with diabetes than among controls (hazard ratio, 1.45; 95% CI, 1.34 to 1.57). In patients with type 2 diabetes, a glycated hemoglobin level outside the target range was the strongest predictor of stroke and acute myocardial infarction; smoking was the strongest predictor of death.
所有研究参与者的中位随访时间为5.7年,其间发生了175,345例死亡。在患有2型糖尿病的患者中,对于目标范围内的每个风险因子变量,结果的过度风险逐步降低。在具有目标范围内的所有五个变量的糖尿病患者中,与对照相比,任何原因导致的死亡风险比为1.06(95%置信区间[CI],1.00至1.12),急性心肌梗死的危险比为0.84(95%CI,0.75至0.93),卒中风险比为0.95(95%CI,0.84至1.07)。糖尿病患者的心力衰竭住院风险始终高于对照组(风险比,1.45; 95%CI,1.34至1.57)。在2型糖尿病患者中,目标范围之外的糖化血红蛋白水平是中风和急性心肌梗死的最强预测因子; 吸烟是死亡的最强预测因子。

CONCLUSIONS
结论
Patients with type 2 diabetes who had five risk-factor variables within the target ranges appeared to have little or no excess risk of death, myocardial infarction, or stroke, as compared with the general population. (Funded by the Swedish Association of Local Authorities and Regions and others.)
与一般人群相比,在目标范围内具有五个风险因子变量的2型糖尿病患者似乎几乎没有过高的死亡,心肌梗塞或中风的风险。 (由瑞典地方当局和地区协会等资助。)

作者:Aidin Rawshani, M.D., Araz Rawshani, M.D., Ph.D., Stefan Franzén, Ph.D., Naveed Sattar, M.D., Ph.D., Björn Eliasson, M.D., Ph.D., Ann-Marie Svensson, Ph.D., Björn Zethelius, M.D., Ph.D., Mervete Miftaraj, M.Sc., Darren K. McGuire, M.D., M.H.Sc., Annika Rosengren, M.D., Ph.D., and Soffia Gudbjörnsdottir, M.D., Ph.D.
发表时间:August 16, 2018
N Engl J Med 2018; 379:633-644
DOI: 10.1056/NEJMoa1800256
文章来源:https://www.nejm.org/doi/full/10.1056/NEJMoa1800256

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