Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
Am J Med. 2010 Jun;123(6):556.e1-9. doi: 10.1016/j.amjmed.2009.11.023.
Type 2 diabetes has been described as a coronary heart disease (CHD) "risk equivalent." We tested whether cardiovascular and all-cause mortality rates were similar between participants with prevalent CHD vs diabetes in an older adult population in whom both glucose disorders and preexisting atherosclerosis are common.
The Cardiovascular Health Study is a longitudinal study of men and women (n=5784) aged > or =65 years at baseline who were followed from baseline (1989/1992-1993) through 2005 for mortality. Diabetes was defined by fasting plasma glucose > or =7.0 mmol/L or use of diabetes control medications. Prevalent CHD was determined by confirmed history of myocardial infarction, angina, or coronary revascularization.
Following multivariable adjustment for other cardiovascular disease risk factors and subclinical atherosclerosis, CHD mortality risk was similar between participants with CHD alone vs diabetes alone (hazard ratio [HR] 1.04, 95% confidence interval [CI], 0.83-1.30). The proportion of mortality attributable to prevalent diabetes (population-attributable risk percent=8.4%) and prevalent CHD (6.7%) was similar in women, but the proportion of mortality attributable to CHD (16.5%) as compared with diabetes (6.4%) was markedly higher in men. Patterns were similar for cardiovascular disease mortality. By contrast, the adjusted relative hazard of total mortality was lower among participants with CHD alone (HR 0.85, 95% CI, 0.75-0.96) as compared with those who had diabetes alone.
Among older adults, diabetes alone confers a risk for cardiovascular mortality similar to that from established clinical CHD. The public health burden of both diabetes and CHD is substantial, particularly among women.
2 型糖尿病被描述为冠心病（CHD）的“等同风险”。我们在一个老年人群中检验了在葡萄糖紊乱和既有动脉粥样硬化均常见的情况下，患有现患 CHD 与糖尿病的参与者之间心血管和全因死亡率是否相似。
心血管健康研究是一项对基线时年龄≥65 岁的男性和女性（n=5784）进行的纵向研究，随访时间从基线（1989/1992-1993 年）到 2005 年，随访终点为死亡率。糖尿病的定义是空腹血糖≥7.0mmol/L 或使用糖尿病控制药物。现患 CHD 是通过确诊的心肌梗死、心绞痛或冠状动脉血运重建病史确定的。
在对其他心血管疾病危险因素和亚临床动脉粥样硬化进行多变量校正后，单独患有 CHD 与单独患有糖尿病的患者的 CHD 死亡率风险相似（风险比[HR]1.04，95%置信区间[CI]0.83-1.30）。在女性中，现患糖尿病（人群归因风险百分比=8.4%）和现患 CHD（6.7%）导致的死亡率比例相似，但男性中 CHD（16.5%）导致的死亡率比例明显高于糖尿病（6.4%）。心血管疾病死亡率的模式也类似。相比之下，与单独患有糖尿病的患者相比，单独患有 CHD 的患者的总死亡率的调整相对危险度较低（HR 0.85，95%CI，0.75-0.96）。
在老年人中，单独的糖尿病导致心血管死亡率的风险与已确立的临床 CHD 相似。糖尿病和 CHD 的公共卫生负担都很大，尤其是在女性中。
