1 Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
2 Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Diab Vasc Dis Res. 2019 Jul;16(4):351-359. doi: 10.1177/1479164119836227. Epub 2019 Apr 3.
We examined the risk of myocardial infarction associated with glucose-lowering therapy among diabetes patients with and without obstructive coronary artery disease.
A cohort of patients with type 1 or type 2 diabetes (n = 12,030), who underwent coronary angiography from 2004 to 2012, were stratified by presence of obstructive (any stenosis ⩾50%) coronary artery disease and by type of diabetes treatment: diet, non-insulin treatment and insulin (±oral anti-diabetics). The primary endpoint was myocardial infarction. Adjusted hazard ratios were calculated using diet-treated patients without coronary artery disease as reference.
In patients without coronary artery disease, risk of myocardial infarction was similar in patients treated with non-insulin medication (adjusted hazard ratio 0.70, 95% confidence interval 0.27-1.81) and insulin (adjusted hazard ratio 0.76, 95% confidence interval 0.27-2.08) as compared to diet only. In patients with coronary artery disease, the risk of myocardial infarction was higher than in the reference group and an incremental risk was observed being lowest in patients treated with diet (adjusted hazard ratio 3.79, 95% confidence interval 1.61-8.88), followed by non-insulin medication (adjusted hazard ratio 5.42, 95% confidence interval 2.40-12.22), and highest in insulin-treated patients (adjusted hazard ratio 7.91, 95% confidence interval 3.51-17.82).
The presence of obstructive coronary artery disease defines the risk of myocardial infarction in diabetes patients. Glucose-lowering therapy, in particular insulin, was associated with risk of myocardial infarction only in the presence of coronary artery disease.
我们研究了伴有和不伴有阻塞性冠状动脉疾病的糖尿病患者使用降糖治疗与心肌梗死风险之间的关系。
对 2004 年至 2012 年间接受冠状动脉造影的 12030 例 1 型或 2 型糖尿病患者进行了研究，这些患者按是否存在阻塞性（任何狭窄 ⩾50%）冠状动脉疾病和糖尿病治疗类型进行分层：饮食、非胰岛素治疗和胰岛素（+口服降糖药）。主要终点是心肌梗死。采用未患冠状动脉疾病的饮食治疗患者作为参照，计算调整后的危险比。
在无冠状动脉疾病的患者中，与仅饮食治疗相比，接受非胰岛素药物治疗（调整后的危险比 0.70，95%置信区间 0.27-1.81）和胰岛素治疗（调整后的危险比 0.76，95%置信区间 0.27-2.08）的患者心肌梗死风险相似。在有冠状动脉疾病的患者中，与参照组相比，心肌梗死风险更高，且观察到的递增风险在饮食治疗患者中最低（调整后的危险比 3.79，95%置信区间 1.61-8.88），其次是非胰岛素药物治疗患者（调整后的危险比 5.42，95%置信区间 2.40-12.22），胰岛素治疗患者最高（调整后的危险比 7.91，95%置信区间 3.51-17.82）。
阻塞性冠状动脉疾病的存在定义了糖尿病患者心肌梗死的风险。只有在存在冠状动脉疾病的情况下，降糖治疗，特别是胰岛素，才与心肌梗死风险相关。
