白蛋白尿与心血管事件和死亡风险在 2 型糖尿病无心血管疾病的一般人群中的相关性：一项丹麦队列研究。
Albuminuria and Risk of Cardiovascular Events and Mortality in a General Population of Patients with Type 2 Diabetes Without Cardiovascular Disease: A Danish Cohort Study.
机构信息
Center for General Practice at Aalborg University, Aalborg, Denmark.
Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark; Department of Cardiology, Atrial Fibrillation Study Group, Aalborg University Hospital, Aalborg, Denmark.
出版信息
Am J Med. 2020 Jun;133(6):e269-e279. doi: 10.1016/j.amjmed.2019.10.042. Epub 2020 Mar 20.
BACKGROUND
Albuminuria level is associated with cardiovascular events and mortality in patients with diabetes. However, little is known about the association between albuminuria level in diabetes patients without overt cardiovascular disease. We aimed to examine the association between albuminuria level and the risk of ischemic stroke, myocardial infarction, and all-cause mortality in patients with type 2 diabetes without overt cardiovascular disease.
METHODS
We linked Danish nationwide registries to identify patients with type 2 diabetes without cardiovascular disease from May 2005 through June 2015. Patients were followed for the outcomes ischemic stroke, myocardial infarction, and all-cause mortality until December 31, 2015. Albuminuria level was based on 2 consecutive measurements of the urinary albumin excretion rate or albumin-to-creatinine ratio. Associations between albuminuria level and incidence of cardiovascular disease and mortality were evaluated with Cox proportional hazard regression.
RESULTS
The study population consisted of 69,532 patients with type 2 diabetes without cardiovascular disease. When comparing patients with microalbuminuria to patients with normoalbuminuria, in an analysis adjusted for cardiovascular risk factors, we found hazard ratios of 1.28 (95% confidence interval [CI], 1.07-1.52), 1.34 (95% CI, 1.10-1.62), and 1.48 (95% CI, 1.36-1.61) for ischemic stroke, myocardial infarction, and all-cause mortality, respectively. For macroalbuminuria, the hazard ratios were 1.81 (95% CI, 1.46-2.23), 1.99 (95% CI, 1.59-2.48), and 1.83 (95% CI, 1.64-2.04). Similar results were found after adjusting for concomitant medication.
CONCLUSIONS
This study showed that albuminuria level is associated with higher risk of incident ischemic stroke, myocardial infarction, and all-cause mortality in Type 2 diabetes patients without overt cardiovascular disease.
背景
白蛋白尿水平与糖尿病患者的心血管事件和死亡率相关。然而，对于无显性心血管疾病的糖尿病患者的白蛋白尿水平与这些事件的关系知之甚少。我们旨在研究无显性心血管疾病的 2 型糖尿病患者的白蛋白尿水平与缺血性卒中、心肌梗死和全因死亡率风险之间的关系。
方法
我们将丹麦全国性登记处进行关联，以确定 2005 年 5 月至 2015 年 6 月期间无心血管疾病的 2 型糖尿病患者。患者在 2015 年 12 月 31 日前随访缺血性卒中、心肌梗死和全因死亡率的结局。白蛋白尿水平基于连续 2 次尿白蛋白排泄率或白蛋白与肌酐比值的测量。使用 Cox 比例风险回归评估白蛋白尿水平与心血管疾病和死亡率发生率之间的关联。
结果
该研究人群包括 69532 例无心血管疾病的 2 型糖尿病患者。与正常白蛋白尿患者相比，在调整心血管危险因素后，微量白蛋白尿患者发生缺血性卒中、心肌梗死和全因死亡率的风险比分别为 1.28（95%置信区间 [CI]，1.07-1.52）、1.34（95%CI，1.10-1.62）和 1.48（95%CI，1.36-1.61）。对于大量白蛋白尿患者，风险比分别为 1.81（95%CI，1.46-2.23）、1.99（95%CI，1.59-2.48）和 1.83（95%CI，1.64-2.04）。在调整伴随药物治疗后，也得到了类似的结果。
结论
本研究表明，白蛋白尿水平与无显性心血管疾病的 2 型糖尿病患者发生缺血性卒中、心肌梗死和全因死亡率的风险增加相关。
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