Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands.
Int J Cardiol. 2017 Dec 1;248:301-307. doi: 10.1016/j.ijcard.2017.07.081. Epub 2017 Jul 23.
Diabetes mellitus is associated with an increased risk for cardiovascular morbidity and mortality. The vascular burden in terms of incidence of cardiovascular events (CVE) and vascular interventions is however poorly quantified. In this study we evaluated the incidence rates of CVE and vascular interventions in patients with type 2 diabetes (T2DM) with and without cardiovascular disease (CVD) in comparison to patients without type 2 diabetes.
In a cohort of 9.808 high-risk patients with and without cardiovascular disease and type 2 diabetes originated from the ongoing, single-center prospective SMART (Second Manifestations of ARTerial disease) cohort, the number and incidence rates of CVE and interventions were calculated. The incidence rates were adjusted for confounders using Poisson regression models. CVE were defined as vascular death, stroke and myocardial infarction (MI). Interventions were defined as percutaneous coronary intervention, coronary artery bypass grafting, percutaneous transluminal angioplasty or stenting of the peripheral arteries and amputation.
Patients with T2DM and CVD had a 4-fold higher incidence rate of CVE and a 8-fold higher incidence rate of vascular interventions compared to high-risk patients without T2DM and CVD after adjusting for confounders. The incidence rate for the composite of non-fatal MI, non-fatal stroke and vascular death was 5.8 per 1000person-years in patients without T2DM or CVD at baseline, 15.2 per 1000person-years in patients with T2DM but without CVD at baseline, 26.0 per 1000person-years in patients without T2DM but with CVD and 40.7 per 1000person-years in patients with both T2DM and CVD at baseline. A similar increasing incidence rate was seen for all vascular interventions from patients without T2DM or CVD to patients with both T2DM and CVD.
Patients with type 2 diabetes or CVD are subject to an increased incidence of cardiovascular events and interventions compared to high-risk patients without type 2 diabetes or vascular disease. Patients with type 2 diabetes and CVD have the highest incidence of new cardiovascular diseases and vascular interventions when compared to patients without type 2 diabetes and CVD. These results underline the need for optimal risk factor treatment as well as the need for new prevention and treatment strategies in this very high risk population.
糖尿病与心血管发病率和死亡率增加有关。然而，心血管事件（CVE）和血管介入的血管负担量化程度较差。在这项研究中，我们评估了有和没有心血管疾病（CVD）的 2 型糖尿病（T2DM）患者与没有 2 型糖尿病的患者相比，CVE 和血管介入的发生率。
在一项源自正在进行的单中心前瞻性 SMART（动脉疾病的第二次表现）队列的 9808 名高危患者中，有和没有心血管疾病和 2 型糖尿病，计算了 CVE 和干预措施的数量和发生率。使用泊松回归模型对混杂因素进行调整后，计算了发病率。CVE 定义为血管死亡、中风和心肌梗死（MI）。干预措施定义为经皮冠状动脉介入治疗、冠状动脉旁路移植术、经皮腔内血管成形术或外周动脉支架置入术和截肢术。
在调整混杂因素后，与没有 T2DM 和 CVD 的高危患者相比，T2DM 和 CVD 患者的 CVE 发生率增加了 4 倍，血管介入的发生率增加了 8 倍。在基线时没有 T2DM 或 CVD 的患者中，非致命性 MI、非致命性中风和血管死亡的复合发生率为 5.8/1000 人年，在基线时没有 T2DM 但有 CVD 的患者中为 15.2/1000 人年，在没有 T2DM 但有 CVD 的患者中为 26.0/1000 人年，在基线时既有 T2DM 又有 CVD 的患者中为 40.7/1000 人年。所有血管介入治疗的发生率均从没有 T2DM 或 CVD 的患者增加到既有 T2DM 又有 CVD 的患者。
与没有 2 型糖尿病或血管疾病的高危患者相比，患有 2 型糖尿病或 CVD 的患者发生心血管事件和介入治疗的发生率增加。与没有 2 型糖尿病和 CVD 的患者相比，患有 2 型糖尿病和 CVD 的患者新发心血管疾病和血管介入治疗的发生率最高。这些结果强调了在这一高危人群中需要进行最佳危险因素治疗以及需要新的预防和治疗策略。
