Du Xin, Ninomiya Toshiharu, de Galan Bastiaan, Abadir Edward, Chalmers John, Pillai Avinesh, Woodward Mark, Cooper Mark, Harrap Stephen, Hamet Pavel, Poulter Neil, Lip Gregory Y H, Patel Anushka
The George Institute for International Health, University of Sydney, Level 10, King George V Building, Royal Prince Alfred Hospital, PO Box M201, Missenden Road, Camperdown, Sydney, NSW 2050, Australia.
Eur Heart J. 2009 May;30(9):1128-35. doi: 10.1093/eurheartj/ehp055. Epub 2009 Mar 11.
The aim of this study was to investigate serious clinical outcomes associated with atrial fibrillation (AF) and the effects of routine blood pressure lowering on such outcomes in the presence or absence of AF, among individuals with type 2 diabetes.
About 11 140 patients with type 2 diabetes (7.6% of whom had AF at baseline) were randomized to a fixed combination of perindopril and indapamide or placebo in the Action in Diabetes and Vascular Disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) study. We compared total mortality and cardiovascular disease outcomes and effects of randomized treatment for 4.3 years on such outcomes between patients with and without AF at baseline. After multiple adjustments, AF was associated with a 61% (95% confidence interval 31-96, P < 0.0001) greater risk of all-cause mortality and comparable higher risks of cardiovascular death, stroke, and heart failure (all P < 0.001). Routine treatment with a fixed combination of perindopril and indapamide produced similar relative, but greater absolute, risk reductions for all-cause and cardiovascular mortalities in patients with AF, compared with those without AF. The number of patients needed to be treated with perindopril-indapamide for 5 years to prevent one cardiovascular death was 42 for patients with AF and 120 for patients without AF at baseline.
Atrial fibrillation is relatively common in type 2 diabetes and is associated with substantially increased risks of death and cardiovascular events in patients with type 2 diabetes. This arrhythmia identifies individuals who are likely to obtain greater absolute benefits from blood pressure-lowering treatment. Atrial fibrillation in diabetic patients should be regarded as a marker of particularly adverse outcome and prompt aggressive management of all risk factors.
本研究旨在调查2型糖尿病患者中与心房颤动（AF）相关的严重临床结局，以及在有或无心房颤动的情况下常规降压治疗对此类结局的影响。
在糖尿病和血管疾病行动：培哚普利吲达帕胺与安慰剂对照评估（ADVANCE）研究中，约11140例2型糖尿病患者（基线时7.6%患有AF）被随机分配至培哚普利和吲达帕胺固定复方制剂或安慰剂组。我们比较了基线时有和无心房颤动患者的全因死亡率和心血管疾病结局，以及随机治疗4.3年对此类结局的影响。经过多次调整后，心房颤动与全因死亡率风险增加61%（95%置信区间31 - 96，P < 0.0001）相关，心血管死亡、中风和心力衰竭风险也同样较高（均P < 0.001）。与无心房颤动的患者相比，培哚普利和吲达帕胺固定复方制剂的常规治疗在心房颤动患者中对全因和心血管死亡率产生了相似的相对风险降低，但绝对风险降低幅度更大。基线时患有心房颤动的患者，使用培哚普利 - 吲达帕胺治疗5年预防1例心血管死亡所需治疗的患者数为42例，而基线时无心房颤动的患者为120例。
心房颤动在2型糖尿病中相对常见，并且与2型糖尿病患者死亡和心血管事件风险大幅增加相关。这种心律失常表明患者可能从降压治疗中获得更大的绝对益处。糖尿病患者的心房颤动应被视为特别不良结局的标志物，并促使积极管理所有风险因素。
