Aune D, Schlesinger S, Norat T, Riboli E
Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom; Bjørknes University College, Oslo, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.
Institute for Biometry and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Germany.
Nutr Metab Cardiovasc Dis. 2018 Jun;28(6):543-556. doi: 10.1016/j.numecd.2018.02.011. Epub 2018 Feb 24.
Although diabetes mellitus is an established risk factor for myocardial infarction and stroke, data on the association with sudden cardiac death are less extensive and the findings have not been entirely consistent. We therefore conducted a systematic review and meta-analysis of prospective studies on diabetes mellitus and risk of sudden cardiac death.
PubMed and Embase databases were searched up to July 18th 2017. Prospective studies that reported adjusted relative risk (RR) estimates and 95% confidence intervals (CIs) for the association between a diabetes diagnosis or pre-diabetes and risk of sudden cardiac death were included. Summary RRs were estimated by use of a random effects model. Nineteen population-based prospective studies (11 publications) (3610 cases, 249,225 participants) and 10 patient-based prospective studies (2713 cases, 55,098 participants) were included. The summary RR for diabetes patients vs. persons without diabetes was 2.02 (95% CI: 1.81-2.25, I = 0%, p = 0.91) in the population-based studies. The summary RR was 1.23 (95% CI: 1.05-1.44, I = 6%, p = 0.34) for the association between pre-diabetes and sudden cardiac death (n = 3 studies, 1000 sudden cardiac deaths, 18,360 participants). In the patient-based studies, the summary RR of sudden cardiac death for diabetes patients vs. patients without diabetes was 1.75 (95% CI: 1.51-2.03, I = 39%, p = 0.10) for all patients combined, 1.63 (95% CI: 1.36-1.97, I = 39%, n = 5) for coronary heart disease patients, and 1.85 (95% CI: 1.48-2.33, I = 0%, n = 3) for heart failure patients.
These results suggest that diabetes patients are at an increased risk of sudden cardiac death both in the general population and among different patient groups.
尽管糖尿病是心肌梗死和中风的既定危险因素，但关于其与心源性猝死关联的数据较少，且研究结果并不完全一致。因此，我们对糖尿病与心源性猝死风险的前瞻性研究进行了系统评价和荟萃分析。
检索了截至2017年7月18日的PubMed和Embase数据库。纳入报告了糖尿病诊断或糖尿病前期与心源性猝死风险之间关联的调整相对风险（RR）估计值和95%置信区间（CI）的前瞻性研究。采用随机效应模型估计汇总RR。纳入了19项基于人群的前瞻性研究（11篇出版物）（3610例病例，249,225名参与者）和10项基于患者的前瞻性研究（2713例病例，55,098名参与者）。在基于人群的研究中，糖尿病患者与非糖尿病患者的汇总RR为2.02（95%CI：1.81-2.25，I² = 0%，p = 0.91）。糖尿病前期与心源性猝死关联的汇总RR为1.23（95%CI：1.05-1.44，I² = 6%，p = 0.34）（n = 3项研究，1000例心源性猝死，18,360名参与者）。在基于患者的研究中，所有患者合并时，糖尿病患者与非糖尿病患者心源性猝死的汇总RR为1.75（95%CI：1.51-2.03，I² = 39%，p = 0.10），冠心病患者为1.63（95%CI：1.36-1.97，I² = 39%，n = 5），心力衰竭患者为1.85（95%CI：1.48-2.33，I² = 0%，n = 3）。
这些结果表明，糖尿病患者在一般人群和不同患者群体中心源性猝死风险均增加。
