Centre for Family Medicine, Karolinska Institutet, Alfred Nobels Allé 12, S-141 83 Huddinge, Sweden.
Diabetol Metab Syndr. 2014 Jan 7;6(1):2. doi: 10.1186/1758-5996-6-2.
To study mortality rates among patients with diabetes and concomitant atrial fibrillation (AF), prescribed different cardiovascular drugs in primary health care.
Study population consisted of men (n = 1319) and women (n = 1094) aged ≥45 years from a database including 75 primary care centres in Sweden. Cox regression analysis, with hazard ratios (HRs), 95% confidence interval (95% CIs) and mortality (years to death) as outcome, and Laplace regression, with difference in time to first 10% mortality (with 95% CI), were performed. Independent variables were prescribed cardiovascular drugs. Regression models were adjusted for a propensity score calculated separately for each prescribed drug class (comprising age, cardiovascular co-morbidities, education, marital status and pharmacotherapy).
Overall mortality was lower in the whole sample for anticoagulants vs no treatment (HR 0.45; 95% CI 0.26-0.77); and among patients < 80 years for anticoagulants vs. antiplatelets (HR 0.44; 95% CI 0.25-0.78); while among individuals aged ≥80 years, antiplatelets (HR 0.47; 95% CI 0.26-0.87) and anticoagulants (HR 0.49; 95% CI 0.24-1.00) vs. no treatment were equally effective. Statins were associated with lower mortality among those <80 years (HR 0.45; 95% CI 0.29-0.71). Laplace regression models in the whole sample, with years to first 10% of total mortality as outcome, were significant for: among patients < 80 years anticoagulants vs. no treatment 2.70 years (95% CI 0.04-5.37), anticoagulants vs. antiplatelets 2.31 years (95% CI 0.84-3.79), and those ≥80 antiplatelets vs. no treatment 1.78 years (95% CI 1.04-2.52).
Our findings suggest that antiplatelets could exert a beneficial effect among those above 80 years.
研究初级保健中患有糖尿病和合并心房颤动（AF）的患者，使用不同心血管药物的死亡率。
研究人群包括来自瑞典 75 个初级保健中心的数据库中的男性（n=1319）和女性（n=1094），年龄≥45 岁。使用 Cox 回归分析，以风险比（HRs）、95%置信区间（95%CI）和死亡率（死亡年限）作为结果，以及使用首次 10%死亡率的差异的拉普拉斯回归（带有 95%CI），进行分析。自变量为处方的心血管药物。回归模型针对每个处方药物类别（包括年龄、心血管合并症、教育程度、婚姻状况和药物治疗）分别计算的倾向评分进行了调整。
在整个样本中，与未治疗相比，抗凝剂的总体死亡率较低（HR 0.45；95%CI 0.26-0.77）；年龄<80 岁的患者中，抗凝剂比抗血小板药物（HR 0.44；95%CI 0.25-0.78）；而年龄≥80 岁的个体中，抗血小板药物（HR 0.47；95%CI 0.26-0.87）和抗凝剂（HR 0.49；95%CI 0.24-1.00）与未治疗同样有效。他汀类药物与<80 岁患者的死亡率降低相关（HR 0.45；95%CI 0.29-0.71）。拉普拉斯回归模型在整个样本中，以总死亡率的首次 10%为结果，具有统计学意义：年龄<80 岁的患者中，抗凝剂与未治疗相比 2.70 年（95%CI 0.04-5.37），抗凝剂与抗血小板药物相比 2.31 年（95%CI 0.84-3.79），年龄≥80 岁的患者中抗血小板药物与未治疗相比 1.78 年（95%CI 1.04-2.52）。
我们的研究结果表明，抗血小板药物可能对 80 岁以上的患者产生有益影响。
