糖尿病、心肌梗死和中风是老年男性后续心血管事件和全因死亡率的不同且与持续时间相关的预测因素。

Diabetes, myocardial infarction and stroke are distinct and duration-dependent predictors of subsequent cardiovascular events and all-cause mortality in older men.

作者信息

Yeap Bu B, McCaul Kieran A, Flicker Leon, Hankey Graeme J, Almeida Osvaldo P, Golledge Jonathan, Norman Paul E

机构信息

School of Medicine and Pharmacology (B.B.Y., L.F., G.J.H.), University of Western Australia, Perth, Western Australia 6009, Department of Endocrinology and Diabetes (B.B.Y.), Fremantle and Fiona Stanley Hospitals, Perth, Western Australia 6160, Western Australian Centre for Health and Ageing (O.P.A., K.A.M., L.F.), Centre for Medical Research, University of Western Australia, Perth, Western Australia 6000, Department of Neurology (G.J.H.), Sir Charles Gairdner Hospital, Perth, Western Australia 6009, School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth, Western Australia 6009, Queensland Research Centre for Peripheral Vascular Disease (J.G.), School of Medicine and Dentistry, James Cook University, Townsville, Queensland 4811; School of Surgery (P.E.N.), University of Western Australia, Perth, Western Australia 6009, Australia.

出版信息

J Clin Endocrinol Metab. 2015 Mar;100(3):1038-47. doi: 10.1210/jc.2014-3339. Epub 2014 Dec 30.

DOI:10.1210/jc.2014-3339

PMID:25548977

Abstract

CONTEXT

The impact of older age and duration of diabetes mellitus on macrovascular complications is unclear.

OBJECTIVE

We tested the hypothesis that in older men, diabetes duration predicts incident cardiovascular events and death, differently from prior myocardial infarction (MI) or stroke.

DESIGN, SETTING, AND PARTICIPANTS: This was a longitudinal cohort study of 11 728 community-dwelling men aged ≥ 65 years in Perth, Western Australia, recruited in 1996-1999.

MAIN OUTCOME MEASURES

We assessed all-cause mortality, and deaths or hospital admissions with MI or stroke between recruitment and December 2010, analyzing age-specific hazard and adjusting for smoking, education, alcohol, exercise, BMI, hypertension, and hypercholesterolemia.

RESULTS

Among 1433 (12.2%) men with diabetes, 208 (14.5%) reported age of onset of diabetes < 55 years, 451 (31.5%) 55-64 years, 679 (47.4%) 65-74 years with 95 (6.6%) > 74 years. Diabetes independently predicted increased all-cause mortality with hazard ratio (HR) of 1.37 (95% confidence interval [CI] = 1.15-1.62) for a duration of 5-9 years, 1.35 (1.18-1.55) for 10-14 years, 1.42 (1.22-1.66) for 15-19 years, and 1.75 (1.45-2.11) for 20-24 years. Mortality from MI was increased for diabetes duration up to 25 years, while stroke-specific mortality increased progressively with diabetes duration. Prior MI or stroke predicted increased risk of subsequent events peaking after 10-20 years.

CONCLUSIONS

In older men, increasing duration of diabetes predicts stable increases in all-cause and MI-related mortality and a progressively higher risk of stroke deaths. Prior MI was associated with increased risk of subsequent MI, and prior stroke with subsequent stroke, particularly in the 10-20 years following the first event. Diabetes is a duration-dependent risk factor for cardiovascular events which influences outcomes differently from prior vascular disease.

摘要

背景

老年及糖尿病病程对大血管并发症的影响尚不清楚。

目的

我们检验了这样一种假设，即在老年男性中，糖尿病病程可预测心血管事件及死亡的发生，这与既往心肌梗死（MI）或中风不同。

设计、地点和参与者：这是一项对1996 - 1999年在西澳大利亚珀斯招募的11728名年龄≥65岁的社区居住男性进行的纵向队列研究。

主要结局指标

我们评估了全因死亡率，以及在招募至2010年12月期间因MI或中风导致的死亡或住院情况，分析了特定年龄的风险，并对吸烟、教育程度、饮酒、运动、体重指数、高血压和高胆固醇血症进行了校正。

结果

在1433名（12.2%）患有糖尿病的男性中，208名（14.5%）报告糖尿病发病年龄<55岁，451名（31.5%）为55 - 64岁，679名（47.4%）为65 - 74岁，95名（6.6%）>74岁。糖尿病独立预测全因死亡率增加，病程5 - 9年时风险比（HR）为1.37（95%置信区间[CI]=1.15 - 1.62），10 - 14年时为1.35（1.18 - 1.55），15 - 19年时为1.42（1.22 - 1.66），20 - 24年时为1.75（1.45 - 2.11）。糖尿病病程长达25年时，MI导致的死亡率增加，而中风特异性死亡率随糖尿病病程逐渐增加。既往MI或中风预测后续事件风险增加，在10 - 20年后达到峰值。