Department of Cardiology, Gentofte Hospital, Niels Andersens Vej 65, DK 2900 Hellerup, Denmark.
Diabetologia. 2010 Aug;53(8):1612-9. doi: 10.1007/s00125-010-1783-z. Epub 2010 May 9.
AIMS/HYPOTHESIS: We assessed secular trends of cardiovascular outcomes following first diagnosis of myocardial infarction (MI) or diabetes in an unselected population.
All Danish residents aged > or = 30 years without prior diabetes or MI were identified by individual-level linkage of nationwide registers. Individuals hospitalised with MI or claiming a first-time prescription for a glucose-lowering medication (GLM) during the period from 1997 to 2006 were included. Analyses were by Poisson regression models. Primary endpoints were death by all causes, cardiovascular death and MI.
The study included 3,092,580 individuals, of whom 77,147 had incident MI and 118,247 new-onset diabetes. MI patients had an increased short-term risk of all endpoints compared with the general population. The rate ratio (RR) for cardiovascular death within the first year after MI was 11.1 (95% CI 10.8-11.5) in men and 14.8 (14.3-15.3) in women, respectively. The risk rapidly declined and 1 year after the index MI, RR was 2.11 (2.00-2.23) and 2.8 (2.64-2.97) in men and women, respectively. Patients with diabetes carried a constantly elevated risk of all endpoints compared with the general population. The cardiovascular death RR was 1.90 (1.77-2.04) and 1.92 (1.78-2.07) in men and women, respectively during the first year after GLM initiation.
CONCLUSIONS/INTERPRETATION: Incident MI is associated with high short-term risk, which decreases rapidly over time. Incident diabetes is associated with a persistent excessive cardiovascular risk after initiation of GLM therapy. This further strengthens the necessity of early multi-factorial intervention in diabetes patients for long-term benefit.
目的/假设：我们评估了在未经选择的人群中，首次诊断为心肌梗死（MI）或糖尿病后心血管结局的长期趋势。
通过全国性登记册的个体水平链接，确定所有年龄≥30 岁且无既往糖尿病或 MI 的丹麦居民。在 1997 年至 2006 年期间，因 MI 住院或首次开具降血糖药物（GLM）处方的患者被纳入研究。分析采用泊松回归模型。主要终点是全因死亡、心血管死亡和 MI。
本研究纳入了 3092580 名患者，其中 77147 例发生 MI，118247 例新诊断为糖尿病。与一般人群相比，MI 患者短期存在所有终点的风险增加。男性 MI 后 1 年内心血管死亡的比率比（RR）为 11.1（95%CI 10.8-11.5），女性为 14.8（14.3-15.3）。风险迅速下降，在 MI 后 1 年，RR 分别为男性 2.11（2.00-2.23）和女性 2.8（2.64-2.97）。与一般人群相比，糖尿病患者所有终点的风险持续升高。GLM 治疗开始后 1 年内，男性和女性的心血管死亡 RR 分别为 1.90（1.77-2.04）和 1.92（1.78-2.07）。
结论/解释：新发 MI 与短期高风险相关，且风险随时间迅速下降。新发糖尿病与 GLM 治疗开始后持续存在的过度心血管风险相关。这进一步强化了对糖尿病患者进行早期多因素干预以获得长期获益的必要性。
