Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Hypertension. 2011 May;57(5):891-7. doi: 10.1161/HYPERTENSIONAHA.110.162446. Epub 2011 Mar 14.
We designed this study to explore to what extent the excess risk of cardiovascular events in diabetic individuals is attributable to hypertension. We retrospectively analyzed prospectively collected data from the Framingham original and offspring cohorts. Of the 1145 Framingham subjects newly diagnosed with diabetes mellitus who did not have a previous history of cardiovascular events, 663 (58%) had hypertension at the time that diabetes mellitus was diagnosed. During 4154 person-years of follow-up, 125 died, and 204 experienced a cardiovascular event. Framingham participants with hypertension at the time of diabetes mellitus diagnosis exhibited higher rates of all-cause mortality (32 versus 20 per 1000 person-years; P<0.001) and cardiovascular events (52 versus 31 per 1000 person-years; P<0.001) compared with normotensive subjects with diabetes mellitus. After adjustment for demographic and clinical covariates, hypertension was associated with a 72% increase in the risk of all-cause death and a 57% increase in the risk of any cardiovascular event in individuals with diabetes mellitus. The population-attributable risk from hypertension in individuals with diabetes mellitus was 30% for all-cause death and 25% for any cardiovascular event (increasing to 44% and 41%, respectively, if the 110 normotensive subjects who developed hypertension during follow-up were excluded from the analysis). In comparison, after adjustment for concurrent hypertension, the population-attributable risk from diabetes mellitus in Framingham subjects was 7% for all-cause mortality and 9% for any cardiovascular disease event. Although diabetes mellitus is associated with increased risks of death and cardiovascular events in Framingham subjects, much of this excess risk is attributable to coexistent hypertension.
我们设计这项研究旨在探讨糖尿病患者发生心血管事件的风险增加在多大程度上归因于高血压。我们对弗雷明汉原队列和后代队列前瞻性收集的数据进行了回顾性分析。在 1145 名新诊断为糖尿病且无心血管事件既往史的弗雷明汉患者中，663 名（58%）在诊断糖尿病时患有高血压。在 4154 人年的随访期间，125 人死亡，204 人发生心血管事件。在诊断糖尿病时患有高血压的弗雷明汉参与者的全因死亡率（每 1000 人年 32 例 vs. 20 例；P<0.001）和心血管事件发生率（每 1000 人年 52 例 vs. 31 例；P<0.001）均高于患有糖尿病的血压正常参与者。在校正人口统计学和临床协变量后，高血压与糖尿病患者全因死亡风险增加 72%和任何心血管事件风险增加 57%相关。在患有糖尿病的个体中，高血压对全因死亡的人群归因风险为 30%，对任何心血管事件的人群归因风险为 25%（如果将随访期间发生高血压的 110 名血压正常受试者排除在分析之外，则分别增加至 44%和 41%）。相比之下，在校正同期高血压后，弗雷明汉参与者中糖尿病对全因死亡率的人群归因风险为 7%，对任何心血管疾病事件的人群归因风险为 9%。尽管糖尿病与弗雷明汉参与者的死亡和心血管事件风险增加相关，但这种额外风险的大部分归因于并存的高血压。
