Manson J E, Colditz G A, Stampfer M J, Willett W C, Krolewski A S, Rosner B, Arky R A, Speizer F E, Hennekens C H
Channing Laboratory, Department of Medicine, Harvard Medical School, Boston, MA.
Arch Intern Med. 1991 Jun;151(6):1141-7.
We examined the relationship of maturity-onset clinical diabetes mellitus with the subsequent incidence of coronary heart disease, stroke, total cardiovascular mortality, and all-cause mortality in a cohort of 116,177 US women who were 30 to 55 years of age and free of known coronary heart disease, stroke, and cancer in 1976. During 8 years of follow-up (889 255 person-years), we identified 338 nonfatal myocardial infarctions, 111 coronary deaths, 259 strokes, 238 cardiovascular deaths, and 1349 deaths from all causes. Diabetes was associated with a markedly increased risk of nonfatal myocardial infarction and fatal coronary heart disease (age-adjusted relative risk [RR] = 6.7; 95% confidence interval [CI], 5.3 to 8.4), ischemic stroke (RR = 5.4; 95% CI, 3.3 to 9.0), total cardiovascular mortality (RR = 6.3; 95% CI, 4.6 to 8.6), and all-cause mortality (RR = 3.0; 95% CI, 2.5 to 3.7). A major independent effect of diabetes persisted in multivariate analyses after simultaneous control for other known coronary risk factors (for these end points, RR [95% CI] = 3.1 [2.3 to 4.2], 3.0 [1.6 to 5.7], 3.0 [1.9 to 4.8], and 1.9 [1.4 to 2.4], respectively). The absolute excess coronary risk due to diabetes was greater in the presence of other risk factors, including cigarette smoking, hypertension, and obesity. These prospective data indicate that maturity-onset clinical diabetes is a strong determinant of coronary heart disease, ischemic stroke, and cardiovascular mortality among middle-aged women. The adverse effect of diabetes is amplified in the presence of other cardiovascular risk factors, many of which are modifiable.
我们在一个由116177名30至55岁的美国女性组成的队列中，研究了成年期临床糖尿病与随后冠心病、中风、心血管疾病总死亡率和全因死亡率的关系，这些女性在1976年时无已知的冠心病、中风和癌症。在8年的随访期（889255人年）内，我们确定了338例非致命性心肌梗死、111例冠心病死亡、259例中风、238例心血管疾病死亡以及1349例全因死亡。糖尿病与非致命性心肌梗死和致命性冠心病风险显著增加相关（年龄调整相对风险[RR]=6.7；95%置信区间[CI]，5.3至8.4），缺血性中风（RR=5.4；95%CI，3.3至9.0），心血管疾病总死亡率（RR=6.3；95%CI，4.6至8.6）和全因死亡率（RR=3.0；95%CI，2.5至3.7）。在同时控制其他已知的冠心病风险因素后，糖尿病的主要独立影响在多变量分析中仍然存在（对于这些终点，RR[95%CI]分别为3.1[2.3至4.2]、3.0[1.6至5.7]、3.0[1.9至4.8]和1.9[1.4至2.4]）。在存在其他风险因素（包括吸烟、高血压和肥胖）的情况下，糖尿病导致的绝对额外冠心病风险更大。这些前瞻性数据表明，成年期临床糖尿病是中年女性冠心病、缺血性中风和心血管疾病死亡率的一个重要决定因素。在存在其他心血管风险因素时，糖尿病的不良影响会放大，其中许多因素是可以改变的。
