Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
Diabetes Care. 2017 Dec;40(12):1763-1770. doi: 10.2337/dc17-1091. Epub 2017 Oct 6.
We evaluated the specific causes of death and their associated risk factors in a contemporary cohort of patients with type 2 diabetes and atherosclerotic cardiovascular disease (ASCVD).
We used data from the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS) study ( = 14,671), a cardiovascular (CV) safety trial adding sitagliptin versus placebo to usual care in patients with type 2 diabetes and ASCVD (median follow-up 3 years). An independent committee blinded to treatment assignment adjudicated each cause of death. Cox proportional hazards models were used to identify risk factors associated with each outcome.
A total of 1,084 deaths were adjudicated as the following: 530 CV (1.2/100 patient-years [PY], 49% of deaths), 338 non-CV (0.77/100 PY, 31% of deaths), and 216 unknown (0.49/100 PY, 20% of deaths). The most common CV death was sudden death ( = 145, 27% of CV death) followed by acute myocardial infarction (MI)/stroke ( = 113 [MI = 48, stroke = 65], 21% of CV death) and heart failure (HF) ( = 63, 12% of CV death). The most common non-CV death was malignancy ( = 154, 46% of non-CV death). The risk of specific CV death subcategories was lower among patients with no baseline history of HF, including sudden death (hazard ratio [HR] 0.4; = 0.0036), MI/stroke death (HR 0.47; = 0.049), and HF death (HR 0.29; = 0.0057).
In this analysis of a contemporary cohort of patients with diabetes and ASCVD, sudden death was the most common subcategory of CV death. HF prevention may represent an avenue to reduce the risk of specific CV death subcategories.
我们评估了 2 型糖尿病和动脉粥样硬化性心血管疾病（ASCVD）患者当代队列中特定死因及其相关危险因素。
我们使用来自 Trial Evaluating Cardiovascular Outcomes with Sitagliptin（TECOS）研究（ = 14671）的数据，这是一项心血管（CV）安全性试验，在 2 型糖尿病和 ASCVD 患者中添加西他列汀与安慰剂相比（中位随访 3 年）。一个独立的委员会对每个死因进行了盲法裁决。Cox 比例风险模型用于确定与每种结局相关的危险因素。
共裁定 1084 例死亡，以下列原因：530 例 CV（1.2/100 患者年[PY]，49%的死亡），338 例非 CV（0.77/100 PY，31%的死亡），和 216 例未知原因（0.49/100 PY，20%的死亡）。最常见的 CV 死亡是猝死（ = 145，27%的 CV 死亡），其次是急性心肌梗死（MI）/中风（ = 113 [MI = 48，中风 = 65]，21%的 CV 死亡）和心力衰竭（HF）（ = 63，12%的 CV 死亡）。最常见的非 CV 死亡是恶性肿瘤（ = 154，46%的非 CV 死亡）。在基线无 HF 病史的患者中，特定 CV 死亡亚类的风险较低，包括猝死（危险比[HR]0.4； = 0.0036）、MI/中风死亡（HR 0.47； = 0.049）和 HF 死亡（HR 0.29； = 0.0057）。
在对当代 2 型糖尿病和 ASCVD 患者队列的分析中，猝死是最常见的 CV 死亡亚类。HF 预防可能是降低特定 CV 死亡亚类风险的一种途径。
