Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, United Kingdom (A.K.W., M.K.R.).
Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, United Kingdom (A.K.W., D.M.A.).
Circulation. 2020 Nov 17;142(20):1925-1936. doi: 10.1161/CIRCULATIONAHA.120.046783. Epub 2020 Nov 16.
To examine the association between the degree of risk factor control and cardiovascular disease (CVD) risk in type 2 diabetes and to assess if the presence of cardio-renal disease modifies these relationships.
A retrospective cohort study using data from English practices from CPRD GOLD (Clinical Practice Research Datalink) and the SCI-Diabetes dataset (Scottish Care Information-Diabetes), with linkage to hospital and mortality data. We identified 101 749 with type 2 diabetes (T2D) in CPRD matched with 378 938 controls without diabetes and 330 892 with type 2 diabetes in SCI-Diabetes between 2006 and 2015. The main exposure was number of optimized risk factors: nonsmoker, total cholesterol ≤4 mmol/L, triglycerides ≤1.7 mmol/L, glycated haemoglobin (HbA1c) ≤53 mmol/mol (≤7.0%), systolic blood pressure <140mm Hg, or <130 mm Hg if high risk. Cox models were used to assess cardiovascular risk associated with levels of risk factor control.
In CPRD, the mean baseline age in T2D was 63 years and 28% had cardio-renal disease (SCI-Diabetes: 62 years; 35% cardio-renal disease). Over 3 years follow-up (SCI-Diabetes: 6 years), CVD events occurred among 27 900 (27%) CPRD-T2D, 101 362 (31%) SCI-Diabetes-T2D, and 75 520 (19%) CPRD-controls. In CPRD, compared with controls, T2D participants with optimal risk factor control (all risk factors controlled) had a higher risk of CVD events (adjusted hazard ratio, 1.21; 95% confidence interval, 1.12-1.29). In T2D participants from CPRD and SCI-Diabetes, pooled hazard ratios for CVD associated with 5 risk factors being elevated versus optimal risk factor control were 1.09 (95% confidence interval, 1.01-1.17) in people with cardio-renal disease but 1.96 (95% confidence interval, 1.82-2.12) in people without cardio-renal disease. People without cardio-renal disease were younger and more likely to have likely to have suboptimal risk factor control but had fewer prescriptions for risk factor modifying medications than those with cardio-renal disease.
Optimally managed people with T2D have a 21% higher CVD risk when compared with controls. People with T2D without cardio-renal disease would be predicted to benefit greatly from CVD risk factor intervention.
研究 2 型糖尿病患者的危险因素控制程度与心血管疾病（CVD）风险之间的关系，并评估是否存在心肾疾病会改变这些关系。
这是一项回顾性队列研究，使用了 CPRD GOLD（临床实践研究数据链接）和 SCI-Diabetes 数据集（苏格兰护理信息糖尿病）中的数据，并与医院和死亡率数据进行了关联。我们在 2006 年至 2015 年期间在 CPRD 中确定了 101749 名 2 型糖尿病（T2D）患者，与 378938 名无糖尿病对照者和 330892 名 2 型糖尿病患者（SCI-Diabetes）相匹配。主要暴露因素是优化的危险因素数量：不吸烟者、总胆固醇≤4mmol/L、甘油三酯≤1.7mmol/L、糖化血红蛋白（HbA1c）≤53mmol/mol（≤7.0%）、收缩压<140mmHg，或高危患者<130mmHg。Cox 模型用于评估与危险因素控制水平相关的心血管风险。
在 CPRD 中，T2D 的基线平均年龄为 63 岁，28%患有心肾疾病（SCI-Diabetes：62 岁；35%心肾疾病）。在 3 年的随访期间（SCI-Diabetes：6 年），CPRD-T2D 中有 27900 人（27%）、SCI-Diabetes-T2D 中有 101362 人（31%）和 CPRD 对照者中有 75520 人（19%）发生 CVD 事件。在 CPRD 中，与对照者相比，T2D 患者的最佳危险因素控制（所有危险因素均得到控制）发生 CVD 事件的风险更高（调整后的危险比，1.21；95%置信区间，1.12-1.29）。在 CPRD 和 SCI-Diabetes 的 T2D 参与者中，与最佳危险因素控制相比，5 项危险因素升高与 CVD 相关的合并危险比为 1.09（95%置信区间，1.01-1.17）在患有心肾疾病的患者中，但在没有心肾疾病的患者中为 1.96（95%置信区间，1.82-2.12）。没有心肾疾病的患者年龄较小，更有可能存在危险因素控制不理想的情况，但与患有心肾疾病的患者相比，他们的危险因素修饰药物处方较少。
与对照者相比，2 型糖尿病患者经最佳治疗后 CVD 风险增加 21%。没有心肾疾病的 2 型糖尿病患者将极大地受益于 CVD 危险因素干预。
