Oslo University Hospital and University of Oslo, Oslo, Norway.
AstraZeneca, Oslo, Norway.
Diabetes Obes Metab. 2020 Sep;22(9):1607-1618. doi: 10.1111/dom.14074. Epub 2020 Jun 3.
To examine the manifestation of cardiovascular or renal disease (CVRD) in patients with type 2 diabetes (T2D) initially free from CVRD as well as the mortality risks associated with these diseases.
Patients free from CVRD were identified from healthcare records in England, Germany, Japan, the Netherlands, Norway and Sweden at a fixed date. CVRD manifestation was defined by first diagnosis of cardiorenal disease, or a stroke, myocardial infarction (MI) or peripheral artery disease (PAD) event. The mortality risk associated with single CVRD history of heart failure (HF), chronic kidney disease (CKD), MI, stroke or PAD was compared with that associated with CVRD-free status.
Of 1 177 896 patients with T2D, 772 336 (66%) were CVRD-free and followed for a mean of 4.5 years. A total of 137 081 patients (18%) developed a first CVRD manifestation, represented by CKD (36%), HF (24%), stroke (16%), MI (14%) and PAD (10%). HF or CKD was associated with increased cardiovascular and all-cause mortality risk: hazard ratio (HR) 2.02 (95% confidence interval [CI] 1.75-2.33) and HR 2.05 (95% CI 1.82-2.32), respectively. HF and CKD were separately associated with significantly increased mortality risks, and the combination was associated with the highest cardiovascular and all-cause mortality risk: HRs 3.91 (95% CI 3.02-5.07) and 3.14 (95% CI 2.90-3.40), respectively.
In a large multinational study of >750 000 CVRD-free patients with T2D, HF and CKD were consistently the most frequent first cardiovascular disease manifestations and were also associated with increased mortality risks. These novel findings show these cardiorenal diseases to be important and serious complications requiring improved preventive strategies.
检查最初无心血管或肾脏疾病（CVRD）的 2 型糖尿病（T2D）患者的心血管或肾脏疾病表现，以及这些疾病相关的死亡风险。
在固定日期，从英国、德国、日本、荷兰、挪威和瑞典的医疗记录中确定无 CVRD 的患者。CVRD 的表现定义为首次诊断出心脏肾脏疾病、中风、心肌梗死（MI）或外周动脉疾病（PAD）。比较心力衰竭（HF）、慢性肾脏病（CKD）、MI、中风或 PAD 的单一 CVRD 病史与无 CVRD 状态相关的死亡风险。
在 1177896 例 T2D 患者中，772336 例（66%）无 CVRD，并平均随访 4.5 年。共有 137081 例患者（18%）出现了首次 CVRD 表现，包括 CKD（36%）、HF（24%）、中风（16%）、MI（14%）和 PAD（10%）。HF 或 CKD 与心血管和全因死亡风险增加相关：风险比（HR）分别为 2.02（95%置信区间 [CI] 1.75-2.33）和 2.05（95% CI 1.82-2.32）。HF 和 CKD 分别与显著增加的死亡率相关，而联合则与最高的心血管和全因死亡率相关：HR 分别为 3.91（95% CI 3.02-5.07）和 3.14（95% CI 2.90-3.40）。
在一项对超过 750000 例无 CVRD 的 T2D 患者进行的大型多国研究中，HF 和 CKD 一直是最常见的首次心血管疾病表现，且与增加的死亡风险相关。这些新发现表明这些心脏肾脏疾病是重要且严重的并发症，需要改进预防策略。
