Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
J Formos Med Assoc. 2012 Nov;111(11):625-36. doi: 10.1016/j.jfma.2012.09.010. Epub 2012 Nov 27.
BACKGROUND/PURPOSE: Cardiovascular complication is the leading cause of mortality in patients with diabetes. Dyslipidemia and hypertension are the major risk factors contributing to cardiovascular disease (CVD). This study was carried out to investigate the prevalence of dyslipidemia and hypertension and their associations with microvascular and macrovascular complications in patients with type 2 diabetes in Taiwan.
Health-care data and diagnostic codes were retrieved from the Taiwan Bureau of National Health Insurance claims files for the years 2000-2009. Based on these data the annual prevalences of dyslipidemia and hypertension were calculated and patients were stratified by age, gender, and diabetic complications.
In patients with diabetes, the prevalence of dyslipidemia increased with age, with the highest rate recorded in adults (inclusive of both genders) between 40 and 65 years of age (p for trend <0.001). The prevalence of hypertension also increased with age with the highest rate seen in adults (inclusive of both genders) >65 years of age (p for trend <0.001). The prevalence of stroke and CVD decreased gradually (p for trend 0.025 and <0.001, respectively), while the prevalence of peripheral vascular disease (PVD) increased in patients with diabetes during the study period (p for trend <0.001). The prevalence of dyslipidemia increased in diabetic patients with eye diseases and in men with nephropathies, but decreased in women with nephropathies during the study period. In contrast, the prevalence of dyslipidemia decreased in patients with macrovascular complications, including CVD and cerebrovascular disease (cerebrovascular accident), but increased in those patients with PVD (p for all trends <0.05). In diabetic patients with various macrovascular complications, except PVD, there was a decrease in the prevalence of hypertension in the past 10 years. The prevalence of hypertension increased in patients with microvascular complications including retinopathy, patients on dialysis (inclusive of both genders), and in men with nephropathy. The prevalence of hypertension along with dyslipidemia increased in patients with microvascular complications including retinopathy, patients on dialysis (inclusive of both genders), and in men with nephropathy; however, the rate decreased in all macrovascular complications except in PVD.
Although progressively increased prevalence of dyslipidemia and hypertension was observed in patients with diabetes in Taiwan, there was a decrease in the prevalence of stroke and CVD in the past 10 years. Among those with macrovascular diseases, except PVD, there was a trend of decreased prevalence of hypertension and dyslipidemia during the study period. In patients with microvascular diseases, prevalence of hypertension and dyslipidemia in patients with eye diseases increased in the past 10 years. More aggressive management of different risk factors is warranted in diabetic patients with various vascular diseases.
背景/目的：心血管并发症是糖尿病患者死亡的主要原因。血脂异常和高血压是导致心血管疾病（CVD）的主要危险因素。本研究旨在调查台湾 2 型糖尿病患者血脂异常和高血压的患病率及其与微血管和大血管并发症的关系。
从 2000 年至 2009 年的台湾国家健康保险局理赔档案中检索医疗数据和诊断代码。根据这些数据计算血脂异常和高血压的年患病率，并按年龄、性别和糖尿病并发症对患者进行分层。
在糖尿病患者中，血脂异常的患病率随年龄增长而增加，40-65 岁年龄段的成年人（包括男女）患病率最高（趋势检验 P<0.001）。高血压的患病率也随年龄增长而增加，65 岁以上成年人（包括男女）的患病率最高（趋势检验 P<0.001）。在研究期间，糖尿病患者的中风和 CVD 患病率逐渐下降（趋势检验 P=0.025 和 P<0.001），而外周血管疾病（PVD）的患病率则增加（趋势检验 P<0.001）。在患有眼病的糖尿病患者和患有肾病的男性中，血脂异常的患病率增加，但在患有肾病的女性中，血脂异常的患病率在研究期间下降。相反，在患有大血管并发症（包括 CVD 和脑血管疾病）的患者中，血脂异常的患病率下降，但在患有 PVD 的患者中，血脂异常的患病率增加（所有趋势检验 P<0.05）。在患有各种大血管并发症（不包括 PVD）的糖尿病患者中，过去 10 年高血压的患病率呈下降趋势。微血管并发症（包括视网膜病变、透析患者[包括男女]和男性肾病患者）患者的高血压患病率增加。微血管并发症（包括视网膜病变、透析患者[包括男女]和男性肾病患者）患者的高血压和血脂异常患病率增加，但在所有大血管并发症（不包括 PVD）中，该比率下降。
尽管台湾糖尿病患者血脂异常和高血压的患病率呈上升趋势，但在过去 10 年中风和 CVD 的患病率有所下降。在患有大血管疾病的患者中，除 PVD 外，研究期间高血压和血脂异常的患病率呈下降趋势。在患有微血管疾病的患者中，过去 10 年眼病患者的高血压和血脂异常患病率增加。需要对患有各种血管疾病的糖尿病患者进行更积极的危险因素管理。
