新发急性冠脉综合征患者的心血管再发事件：糖尿病的影响及其药物治疗管理。

Recurrent cardiovascular events in patients with newly diagnosed acute coronary syndrome: Influence of diabetes and its management with medication.

机构信息

Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.

Graduate School of Medicine, Keio University, Tokyo, Japan; Department of Diabetes, Yotsukaido Tokushukai Medical Center, Chiba, Japan.

出版信息

J Diabetes Complications. 2020 Mar;34(3):107511. doi: 10.1016/j.jdiacomp.2019.107511. Epub 2019 Dec 16.

DOI:10.1016/j.jdiacomp.2019.107511

PMID:31928892

Abstract

AIMS

The effects of type 2 diabetes mellitus (T2DM) medications on secondary prevention after acute coronary syndrome (ACS) remain unclear. We evaluated recurrent cardiovascular disease (CVD) after primary diagnosis of ACS in T2DM patients.

METHODS

This retrospective cohort study included 569 patients with newly diagnosed ACS from 2007 to 2012. The endpoint was recurrent CVD up to a five-year maximum follow-up until 2016. Kaplan-Meier analysis and Cox proportional hazard regressions were performed to examine the association between T2DM diagnosis, different antidiabetic drugs, and recurrent CVD.

RESULTS

Among 569 patients, 198 had T2DM. The mean follow-up was 1540 (interquartile range, 864-2157) days. Patients with diabetes showed higher risk of recurrent cardiovascular event compared with those without (P = 0.004). Patients with diabetes treated with metformin (65 patients) showed longer event-free survival, compared with those on other antidiabetic medications (P = 0.005). Multivariable analysis confirmed a reduced risk of recurrent CVD associated with metformin (hazard ratio, 0.33; 95% confidence interval, 0.12-0.91), while lower hemoglobin A1c levels on admission were not associated with better CVD outcomes.

CONCLUSIONS

T2DM increases risk of recurrent CVD after first ACS episode regardless of glycemic control on admission, while use of metformin may reduce recurrence.

摘要

目的

2 型糖尿病（T2DM）药物对急性冠脉综合征（ACS）后二级预防的影响仍不清楚。我们评估了 T2DM 患者首次 ACS 后复发性心血管疾病（CVD）的情况。

方法

这是一项回顾性队列研究，纳入了 2007 年至 2012 年期间新诊断为 ACS 的 569 例患者。终点是在 2016 年之前最长 5 年的随访期间，复发性 CVD 的发生情况。采用 Kaplan-Meier 分析和 Cox 比例风险回归来检查 T2DM 诊断、不同抗糖尿病药物与复发性 CVD 之间的关系。

结果

在 569 例患者中，有 198 例患有 T2DM。平均随访时间为 1540 天（四分位距，864-2157）。与无糖尿病患者相比，糖尿病患者复发性心血管事件的风险更高（P=0.004）。与其他抗糖尿病药物相比，接受二甲双胍（65 例）治疗的糖尿病患者的无事件生存时间更长（P=0.005）。多变量分析证实，与其他抗糖尿病药物相比，使用二甲双胍可降低复发性 CVD 的风险（风险比，0.33；95%置信区间，0.12-0.91），而入院时较低的糖化血红蛋白水平与更好的 CVD 结局无关。