2 型糖尿病与多种心血管疾病发病风险：一项涉及 190 万人的队列研究。

Type 2 diabetes and incidence of a wide range of cardiovascular diseases: a cohort study in 1·9 million people.

机构信息

Farr Institute of Health Informatics Research, University College London, London, UK.

MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK.

出版信息

Lancet. 2015 Feb 26;385 Suppl 1:S86. doi: 10.1016/S0140-6736(15)60401-9.

DOI:10.1016/S0140-6736(15)60401-9

PMID:26312908

Abstract

BACKGROUND

The contemporary associations of type 2 diabetes with a wide range of incident cardiovascular diseases have not been compared. Previous studies have focussed on myocardial infarction and stroke, and these conditions are the usual outcomes chosen in clinical trials in type 2 diabetes, but other diseases such as heart failure and angina are also major causes of morbidity in diabetes. We aimed to study associations between type 2 diabetes and 12 initial manifestations of cardiovascular disease.

METHODS

We used linked electronic health records from 1997 to 2010 in the CALIBER (cardiovascular research using linked bespoke studies and electronic health records) programme to investigate the absolute and relative risks associated with type 2 diabetes in a cohort of 1·92 million patients in England. We included patients aged 30 years and older who were free from cardiovascular disease at baseline. This study is registered with ClinicalTrials.gov, number NCT01804439.

FINDINGS

We observed 113 638 first presentations of cardiovascular disease during a median follow-up of 5·5 years (IQR 2·1-10·1). 34 198 people had type 2 diabetes: 6137 experienced a first cardiovascular presentation, of which the most common were peripheral arterial disease (16·2%, n=992) and heart failure (14·1%, n=866). Type 2 diabetes was strongly positively associated with peripheral arterial disease (adjusted cause-specific hazard ratio 2·98, 95% CI 2·76-3·22), ischaemic stroke (1·72, 1·52-1·95), stable angina (1·62, 1·49-1·77), heart failure (1·56, 1·45-1·69), and non-fatal myocardial infarction (1·54 1·42-1·67), but inversely associated with abdominal aortic aneurysm (0·46, 0·35-0·59) and subarachnoid haemorrhage (0·48, 0·26-0·89).

INTERPRETATION

This study suggests that associations of type 2 diabetes vary with different incident cardiovascular diseases. These findings have implications for clinical risk assessment and choice of primary endpoint in trials on type 2 diabetes.

FUNDING

Wellcome Trust, National Institute for Health Research, UK Medical Research Council.

摘要

背景

目前尚未对 2 型糖尿病与多种心血管疾病之间的关联进行比较。既往研究主要关注心肌梗死和卒中，而这些疾病是 2 型糖尿病临床试验中的常见结局，但心力衰竭和心绞痛等其他疾病也是糖尿病患者的主要发病原因。本研究旨在研究 2 型糖尿病与心血管疾病 12 种首发表现之间的关联。

方法

我们使用 1997 年至 2010 年期间在 CALIBER（利用定制研究和电子健康记录进行心血管研究）项目中链接的电子健康记录，在英格兰的 192 万患者队列中研究 2 型糖尿病与绝对风险和相对风险之间的关联。我们纳入了年龄在 30 岁及以上且在基线时无心血管疾病的患者。本研究在 ClinicalTrials.gov 注册，编号为 NCT01804439。

结果

在中位随访 5.5 年（IQR 2.1-10.1）期间，我们观察到 113638 例首发心血管疾病。34198 例患者患有 2 型糖尿病：6137 例患者出现首发心血管事件，其中最常见的是外周动脉疾病（16.2%，n=992）和心力衰竭（14.1%，n=866）。2 型糖尿病与外周动脉疾病显著正相关（校正后的特定病因风险比 2.98，95%CI 2.76-3.22）、缺血性卒中（1.72，1.52-1.95）、稳定性心绞痛（1.62，1.49-1.77）、心力衰竭（1.56，1.45-1.69）和非致死性心肌梗死（1.54，1.42-1.67），但与腹主动脉瘤（0.46，0.35-0.59）和蛛网膜下腔出血（0.48，0.26-0.89）呈负相关。