Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan.
Division of Diabetes and Endocrinology and Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
J Clin Endocrinol Metab. 2019 Nov 1;104(11):5084-5090. doi: 10.1210/jc.2019-00168.
To determine the degree of control of multiple risk factors under real-world conditions for coronary artery disease (CAD) according to the presence or absence of diabetes mellitus (DM) and to determine whether reaching multifactorial targets for blood pressure (BP), low-density lipoprotein-cholesterol (LDL-C), HbA1c, and current smoking is associated with lower risks for CAD.
We investigated the effects on subsequent CAD of the number of controlled risk factors among BP, LDL-C, HbA1c, and current smoking in a prospective cohort study using a nationwide claims database of 220,894 individuals in Japan. Cox regression examined risks over a 4.8-year follow-up.
The largest percentage of participants had two risk factors at target in patients with DM (39.6%) and subjects without DM (36.4%). Compared with those who had two targets achieved, the risks of CAD among those who had any one and no target achieved were two and four times greater, respectively, regardless of the presence of DM. The effect of composite control was sufficient to bring CAD risk in patients with DM below that for subjects without DM with any two targets achieved, whereas the risk of CAD in the DM group with all four risk factors uncontrolled was 9.4 times more than in the non-DM group who had achieved two targets.
These findings show that composite control of modifiable risk factors has a large effect in patients with and without DM. The effect was sufficient to bring CAD risk in patients with DM below that in the non-DM group who had two targets achieved.
根据是否患有糖尿病（DM），确定在真实环境下冠心病（CAD）的多种危险因素控制程度，并确定是否达到血压（BP）、低密度脂蛋白胆固醇（LDL-C）、HbA1c 和当前吸烟的多因素目标与 CAD 风险降低相关。
我们使用日本全国范围内的一项全国性理赔数据库，对 220894 名个体进行前瞻性队列研究，研究了 BP、LDL-C、HbA1c 和当前吸烟的控制风险因素数量对随后 CAD 的影响。Cox 回归分析了 4.8 年随访期间的风险。
在患有 DM 的患者（39.6%）和不患有 DM 的患者（36.4%）中，最大比例的参与者有两个目标风险因素。与达到两个目标的患者相比，无论是否患有 DM，仅达到一个目标和未达到任何目标的患者的 CAD 风险分别增加了两倍和四倍。复合控制的效果足以使 DM 患者的 CAD 风险低于仅达到两个目标的非 DM 患者，而未控制四个风险因素的 DM 患者的 CAD 风险是非 DM 患者的四倍多，仅达到两个目标。
这些发现表明，对可改变风险因素的综合控制对患有和不患有 DM 的患者都有很大的影响。效果足以使 DM 患者的 CAD 风险低于仅达到两个目标的非 DM 患者。
