Medicine Department, Hospital Universitario Gregorio Marañon, Madrid, Comunidad De Madrid, Spain.
Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avda. de Atenas s/n, 28922, Alcorcon, Madrid, Comunidad De Madrid, Spain.
Cardiovasc Diabetol. 2017 Oct 10;16(1):126. doi: 10.1186/s12933-017-0609-4.
Diabetes mellitus has long been associated with cardiovascular events. Nevertheless, the higher burden of traditional cardiovascular risk factors reported in high-income countries is offset by a more widespread use of preventive measures and revascularization or other invasive procedures. The aim of this investigation is to describe trends in number of cases and outcomes, in-hospital mortality (IHM) and length of hospital stay (LHS), of hospital admissions for major cardiovascular events between type 2 diabetes (T2DM) and matched non-diabetes patients.
Retrospective study using National Hospital Discharge Database, analyzed in 4 years 2002, 2006, 2010, 2014, in Spain. We included patients (≥ 40 years old) with a primary diagnosis of myocardial infarction, ischemic and hemorrhagic stroke, aortic aneurysm and dissection and acute lower limb ischemia in people with T2DM. Cases were matched with controls (without T2DM) by ICD-9-CM codes, sex, age, province of residence and year.
We selected 130,011 matched couples (50,427 with myocardial infarction, 60,236 with stroke, 2599 with aortic aneurysm and dissection and 16,749 with acute lower limb ischemia. Among T2DM patients we found increasing numbers of admissions overtime for stroke (10,794 in 2002 vs 17,559 in 2014), aortic aneurysm and dissection (390 vs 841) and acute lower limb ischemia (3854 vs. 4548). People were progressively older (except for myocardial infarction), had more comorbidities (especially T2DM patients), and were more frequently coded overtime for cardiovascular risk factors (smoking, obesity, hypertension, lipid disorders) and renal diseases. LHS and IHM declined overtime, though IHM only did it significantly in T2DM patients. Multivariable adjustment showed that T2DM patients had a significantly 15% higher mortality rate during admission for myocardial infarction, a 6% higher mortality for stroke, and a 6% higher mortality rate for "all cardiovascular events combined", than non-diabetic matched controls.
The number of hospital admissions for stroke, aortic aneurysm and dissection and acute lower limb ischemia increased overtime, but remained stable for myocardial infarction. T2DM is associated to higher IHM after major cardiovascular events. Further research is needed to help us understand the reasons for an apparently increased mortality in T2DM patients when admitted to hospital for some major cardiovascular events.
糖尿病与心血管事件长期相关。然而，高收入国家报告的传统心血管危险因素负担更高，但由于更广泛地使用预防措施、血运重建或其他侵入性手术而得到了弥补。本研究旨在描述 2 型糖尿病（T2DM）与匹配的非糖尿病患者主要心血管事件住院病例数和结局、院内死亡率（IHM）和住院时间（LHS）的变化趋势。
这是一项回顾性研究，使用了西班牙国家住院数据库，分析了 2002 年、2006 年、2010 年和 2014 年的 4 年数据。我们纳入了≥40 岁的患者，这些患者患有心肌梗死、缺血性和出血性卒中等原发性诊断，以及 T2DM 患者的主动脉瘤和夹层及急性下肢缺血。通过 ICD-9-CM 编码、性别、年龄、居住地和年份，将病例与对照组（无 T2DM）相匹配。
我们选择了 130011 对匹配的患者（50427 例心肌梗死、60236 例卒中、2599 例主动脉瘤和夹层、16749 例急性下肢缺血）。在 T2DM 患者中，我们发现随着时间的推移，住院治疗的卒中病例数不断增加（2002 年为 10794 例，2014 年为 17559 例），主动脉瘤和夹层（390 例对 841 例）和急性下肢缺血（3854 例对 4548 例）。患者年龄逐渐增大（心肌梗死除外），合并症更多（尤其是 T2DM 患者），心血管危险因素（吸烟、肥胖、高血压、血脂紊乱）和肾脏疾病编码也更多。尽管 IHM 仅在 T2DM 患者中显著下降，但随着时间的推移，LHS 和 IHM 呈下降趋势。多变量调整显示，与非糖尿病匹配对照组相比，T2DM 患者心肌梗死住院期间死亡率高出 15%，卒中死亡率高出 6%，“所有心血管事件综合死亡率”高出 6%。
随着时间的推移，卒中、主动脉瘤和夹层以及急性下肢缺血的住院人数不断增加，但心肌梗死的住院人数保持稳定。T2DM 与主要心血管事件后较高的 IHM 相关。需要进一步研究以帮助我们了解为什么 T2DM 患者在因某些主要心血管事件住院时死亡率明显升高的原因。
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