Eeg-Olofsson Katarina, Zethelius Björn, Gudbjörnsdottir Soffia, Eliasson Björn, Svensson Ann-Marie, Cederholm Jan
Department of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
Geriatrics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden Medical Products Agency, Uppsala, Sweden.
Diab Vasc Dis Res. 2016 Jul;13(4):268-77. doi: 10.1177/1479164116637311. Epub 2016 Apr 21.
Assess the effect of risk factors changes on risk for cardiovascular disease and mortality in patients with type 2 diabetes selected from the Swedish National Diabetes Register.
Observational study of 13,477 females and males aged 30-75 years, with baseline HbA1c 41-67 mmol/mol, systolic blood pressure 122-154 mmHg and ratio non-HDL:HDL 1.7-4.1, followed for mean 6.5 years until 2012. Four groups were created: a reference group (n = 6757) with increasing final versus baseline HbA1c, systolic blood pressure and non-HDL:HDL cholesterol during the study period, and three groups with decreasing HbA1c (n = 1925), HbA1c and systolic blood pressure (n = 2050) or HbA1c and systolic blood pressure and non-HDL:HDL (n = 2745).
Relative risk reduction for fatal/nonfatal cardiovascular disease was 35% with decrease in HbA1c only (mean 6 to final 49 mmol/mol), 56% with decrease in HbA1c and systolic blood pressure (mean 12 to final 128 mmHg) and 75% with combined decreases in HbA1c, systolic blood pressure and non-HDL:HDL (mean 0.8 to final 2.1), all p < 0.001 adjusting for clinical characteristics, other risk factors, treatments and previous cardiovascular disease. Similar risk reductions were found for fatal/nonfatal coronary heart disease, fatal cardiovascular disease, all-cause mortality and also in a subgroup of 3038 patients with albuminuria.
Considerable risk reductions for cardiovascular disease and mortality were seen with combined long-term risk factor improvement.
评估从瑞典国家糖尿病登记处选取的2型糖尿病患者中，危险因素变化对心血管疾病风险和死亡率的影响。
对13477名年龄在30 - 75岁的男性和女性进行观察性研究，基线糖化血红蛋白（HbA1c）为41 - 67 mmol/mol，收缩压为122 - 154 mmHg，非高密度脂蛋白（non-HDL）与高密度脂蛋白（HDL）比值为1.7 - 4.1，随访至2012年，平均随访6.5年。创建了四组：一个参照组（n = 6757），在研究期间最终糖化血红蛋白、收缩压和非HDL:HDL胆固醇较基线升高；另外三组糖化血红蛋白降低（n = 1925）、糖化血红蛋白和收缩压降低（n = 2050）或糖化血红蛋白、收缩压和非HDL:HDL降低（n = 2745）。
仅糖化血红蛋白降低（平均从6降至最终的49 mmol/mol）时，致命/非致命心血管疾病的相对风险降低35%；糖化血红蛋白和收缩压降低（平均从12降至最终的128 mmHg）时，相对风险降低56%；糖化血红蛋白、收缩压和非HDL:HDL联合降低（平均从0.8降至最终的2.1）时，相对风险降低75%，在对临床特征、其他危险因素、治疗和既往心血管疾病进行校正后，所有p < 0.001。在致命/非致命冠心病、致命心血管疾病、全因死亡率以及3038例蛋白尿患者亚组中也发现了类似的风险降低情况。
长期联合改善危险因素可使心血管疾病和死亡率显著降低。
