Tsujimoto Tetsuro, Sugiyama Takehiro, Kajio Hiroshi
Department of Diabetes, Endocrinology and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan.
Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.
Diabetes Obes Metab. 2017 Jun;19(6):800-808. doi: 10.1111/dom.12878. Epub 2017 Feb 17.
To assess whether the use of beta-blockers influences mortality and the incidence of major cardiovascular events in patients with diabetes and coronary heart disease (CHD).
Using data from the Bypass Angioplasty Revascularization Investigation 2 Diabetes trial, we performed Cox proportional hazards analysis to assess the effects of β-blockers on all-cause mortality in 2244 patients with type 2 diabetes who had stable CHD with and without a history of myocardial infarction (MI)/heart failure with reduced left ventricular ejection fraction (HFrEF).
All-cause mortality in patients with MI/HFrEF was significantly lower in those receiving β-blockers than in those not receiving β-blockers (adjusted hazard ratio [HR] 0.60, 95% confidence interval [CI] 0.37-0.98; P = .04), whereas that in patients without MI/HFrEF did not significantly differ (adjusted HR 0.91, 95% CI 0.76-1.32; P = .64). Among patients with MI/HFrEF, all-cause mortality in those who received intensive medical therapy alone for CHD was significantly lower in those on β-blockers than in those not on β-blockers (adjusted HR 0.45, 95% CI 0.23-0.88; P = .02); however, mortality in patients who received early revascularization for CHD was not significantly lower in those on β-blockers (adjusted HR 0.81, 95% CI 0.40-1.65; P = .57). The risk of major cardiovascular events in patients without MI/HFrEF was not significantly different between those on and those not on β-blocker treatment.
In patients with diabetes and CHD, the use of β-blockers was effective in reducing all-cause mortality in those with MI/HFrEF but not in those without MI/HFrEF.
评估使用β受体阻滞剂是否会影响糖尿病合并冠心病（CHD）患者的死亡率和主要心血管事件的发生率。
利用来自“旁路血管成形术血运重建调查2糖尿病”试验的数据，我们进行了Cox比例风险分析，以评估β受体阻滞剂对2244例患有稳定冠心病且有或无心肌梗死（MI）/左心室射血分数降低的心力衰竭（HFrEF）病史的2型糖尿病患者全因死亡率的影响。
MI/HFrEF患者中，接受β受体阻滞剂治疗的患者全因死亡率显著低于未接受β受体阻滞剂治疗的患者（调整后风险比[HR]0.60，95%置信区间[CI]0.37 - 0.98；P = 0.04），而无MI/HFrEF患者的全因死亡率无显著差异（调整后HR 0.91，95%CI 0.76 - 1.32；P = 0.64）。在MI/HFrEF患者中，仅接受冠心病强化药物治疗的患者中，使用β受体阻滞剂的患者全因死亡率显著低于未使用β受体阻滞剂的患者（调整后HR 0.45，95%CI 0.23 - 0.88；P = 0.02）；然而，接受冠心病早期血运重建治疗的患者中，使用β受体阻滞剂的患者死亡率无显著降低（调整后HR 0.81，95%CI 0.40 - 1.65；P = 0.57）。未发生MI/HFrEF的患者中，接受β受体阻滞剂治疗和未接受β受体阻滞剂治疗的患者发生主要心血管事件的风险无显著差异。
在糖尿病合并冠心病患者中，使用β受体阻滞剂可有效降低MI/HFrEF患者的全因死亡率，但对无MI/HFrEF患者无效。
