Giorda Carlo B, Avogaro Angelo, Maggini Marina, Lombardo Flavia, Mannucci Edoardo, Turco Salvatore, Alegiani Stefania Spila, Raschetti Roberto, Velussi Mario, Ferrannini Ele
Metabolism and Diabetes Unit, Regione Piemonte, Chieri, Italy.
Diabetes Care. 2008 Nov;31(11):2154-9. doi: 10.2337/dc08-1013. Epub 2008 Sep 9.
The purpose of this study was to assess incidence of and risk factors for recurrent cardiovascular disease (CVD) in type 2 diabetes.
We estimated the incidence of recurrent cardiovascular events in type 2 diabetic patients, aged 40-97 years, followed by a network of diabetes clinics. The analysis was conducted separately for 2,788 patients with CVD at enrollment (cohort A) and for 844 patients developing the first episode during the observation period (cohort B).
During 4 years of follow-up, in cohort A the age-adjusted incidence of a recurrent event (per 1,000 person-years) was 72.7 (95% CI 58.3-87.1) in men and 32.5 (21.2-43.7) in women, whereas in cohort B it was 40.1 (17.4-62.9) in men and 22.4 (12.9-32.0) in women. After controls were included for potential predictors (familial CVD, obesity, smoking, diabetes duration, glycemic control, microvascular complications, geographic area, and antihypertensive and lipid-lowering treatment), male sex, older age, and insulin use were significant independent risk predictors (cohort A) and serum triglyceride levels >/=1.69 mmol/l emerged as the only metabolic (negative) prognostic factor (cohort B). In both cohorts, a prior CVD episode, especially myocardial infarction, was by far the strongest predictor of recurrent CVD.
Approximately 6% of unselected diabetic patients in secondary prevention develop recurrent major CVD every year. Those with long-standing previous CVD show a higher incidence of recurrence. Male sex, age, high triglyceride levels, and insulin use are additional predictors of recurrence.
本研究旨在评估2型糖尿病患者心血管疾病（CVD）复发的发生率及危险因素。
我们对年龄在40 - 97岁的2型糖尿病患者进行随访，这些患者由糖尿病诊所网络跟踪。分析分别针对入组时患有CVD的2788例患者（队列A）和在观察期内首次发生CVD的844例患者（队列B）进行。
在4年的随访期间，队列A中，经年龄调整后的复发事件发生率（每1000人年）男性为72.7（95%可信区间58.3 - 87.1），女性为32.5（21.2 - 43.7）；而在队列B中，男性为40.1（17.4 - 62.9），女性为22.4（12.9 - 32.0）。在纳入潜在预测因素（家族性CVD、肥胖、吸烟、糖尿病病程、血糖控制、微血管并发症、地理区域以及降压和降脂治疗）后，男性、高龄和胰岛素使用是显著的独立风险预测因素（队列A），血清甘油三酯水平≥1.69 mmol/l成为唯一的代谢（负面）预后因素（队列B）。在两个队列中，既往CVD发作，尤其是心肌梗死，是CVD复发最强的预测因素。
在二级预防中，约6%未经选择的糖尿病患者每年会发生复发性严重CVD。既往有长期CVD的患者复发率更高。男性、年龄、高甘油三酯水平和胰岛素使用是复发的其他预测因素。
