Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institute, Stockholm, Sweden.
UCR-Uppsala Clinical Research center, Uppsala Clinical Research center, Uppsala, Sweden.
BMJ Open. 2019 Apr 3;9(4):e027199. doi: 10.1136/bmjopen-2018-027199.
To compare short-term cardiovascular (CV) outcome in type 2 diabetes (T2D) patients without ischaemic heart disease (IHD), with IHD but no prior myocardial infarction (MI), and those with prior MI; and assess the impact on risk of age when initiating first-time glucose-lowering drug (GLD).
Cohort study linking morbidity, mortality and medication data from Swedish national registries.
First-time users of GLD during 2007-2016.
Predicted cumulative incidence for the CV outcome (MI, stroke and CV mortality) was estimated. A Cox model was developed where age at GLD start and CV risk was modelled.
260 070 first-time GLD users were included, 221 226 (85%) had no IHD, 16 294 (6%) had stable IHD-prior MI and 22 550 (9%) had IHD+MI. T2D patients without IHD had a lower risk of CV outcome compared with the IHD populations (±prior MI), (3-year incidence 4.78% vs 5.85% and 8.04%). The difference in CV outcome was primarily driven by a relative greater MI risk among the IHD patients. For T2D patients without IHD, an almost linear association between age at start of GLD and relative risk was observed, whereas in IHD patients, the younger (<60 years) patients had a relative greater risk compared with older patients.
T2D patients without IHD had a lower risk of the CV outcome compared with the T2D populations with IHD, primarily driven by a greater risk of MI. For T2D patients without IHD, an almost linear association between age at start of GLD and relative risk was observed, whereas in IHD patients, the younger patients had a relative greater risk compared with older patients. Our findings suggest that intense risk prevention should be the key strategy in the management of T2D patients, especially for younger patients.
比较 2 型糖尿病（T2D）患者无缺血性心脏病（IHD）、有 IHD 但无心肌梗死（MI）病史和有 MI 病史患者的短期心血管（CV）结局，并评估首次使用降糖药物（GLD）时年龄对风险的影响。
链接瑞典国家登记处发病率、死亡率和药物使用数据的队列研究。
2007 年至 2016 年首次使用 GLD 的患者。
估计 CV 结局（MI、卒中和 CV 死亡率）的预测累积发生率。建立 Cox 模型，对 GLD 起始时的年龄和 CV 风险进行建模。
共纳入 260070 例首次 GLD 使用者，其中 221226 例（85%）无 IHD，16294 例（6%）有稳定 IHD-既往 MI，22550 例（9%）有 IHD+MI。无 IHD 的 T2D 患者的 CV 结局风险低于 IHD 人群（±既往 MI）（3 年发生率分别为 4.78%和 5.85%和 8.04%）。CV 结局的差异主要归因于 IHD 患者的 MI 风险相对较高。对于无 IHD 的 T2D 患者，GLD 起始年龄与相对风险之间存在近乎线性的关联，而在 IHD 患者中，年轻（<60 岁）患者的风险相对大于老年患者。
无 IHD 的 T2D 患者的 CV 结局风险低于有 IHD 的 T2D 患者，主要归因于 MI 风险较高。对于无 IHD 的 T2D 患者，GLD 起始年龄与相对风险之间存在近乎线性的关联，而在 IHD 患者中，年轻患者的风险相对大于老年患者。我们的研究结果表明，在 T2D 患者的管理中，应将强化风险预防作为关键策略，尤其是对于年轻患者。
