糖尿病合并慢性肾脏病患者的心血管疾病事件再发风险。
Risk for recurrent cardiovascular disease events among patients with diabetes and chronic kidney disease.
机构信息
Department of Epidemiology, University of Alabama At Birmingham, 1665 University Blvd, RPHB 140J, Birmingham, AL, 35233-0013, USA.
Mount Sinai Heart, Icahn School of Medicine At Mount Sinai, New York, NY, USA.
出版信息
Cardiovasc Diabetol. 2021 Mar 1;20(1):58. doi: 10.1186/s12933-021-01247-0.
BACKGROUND
Adults who have experienced multiple cardiovascular disease (CVD) events have a very high risk for additional events. Diabetes and chronic kidney disease (CKD) are each associated with an increased risk for recurrent CVD events following a myocardial infarction (MI).
METHODS
We compared the risk for recurrent CVD events among US adults with health insurance who were hospitalized for an MI between 2014 and 2017 and had (1) CVD prior to their MI but were free from diabetes or CKD (prior CVD), and those without CVD prior to their MI who had (2) diabetes only, (3) CKD only and (4) both diabetes and CKD. We followed patients from hospital discharge through December 31, 2018 for recurrent CVD events including coronary, stroke, and peripheral artery events.
RESULTS
Among 162,730 patients, 55.2% had prior CVD, and 28.3%, 8.3%, and 8.2% had diabetes only, CKD only, and both diabetes and CKD, respectively. The rate for recurrent CVD events per 1000 person-years was 135 among patients with prior CVD and 110, 124 and 171 among those with diabetes only, CKD only and both diabetes and CKD, respectively. Compared to patients with prior CVD, the multivariable-adjusted hazard ratio for recurrent CVD events was 0.92 (95%CI 0.90-0.95), 0.89 (95%CI: 0.85-0.93), and 1.18 (95%CI: 1.14-1.22) among those with diabetes only, CKD only, and both diabetes and CKD, respectively.
CONCLUSION
Following MI, adults with both diabetes and CKD had a higher risk for recurrent CVD events compared to those with prior CVD without diabetes or CKD.
背景
经历过多次心血管疾病（CVD）事件的成年人再次发生心血管事件的风险非常高。糖尿病和慢性肾脏病（CKD）均与心肌梗死（MI）后再次发生 CVD 事件的风险增加有关。
方法
我们比较了 2014 年至 2017 年期间因 MI 住院的美国有医疗保险的成年人中，（1）在 MI 前患有 CVD 但无糖尿病或 CKD（既往 CVD），以及（2）在 MI 前无 CVD 但患有（2）糖尿病，（3）CKD 仅患有，和（4）患有糖尿病和 CKD 的患者再次发生 CVD 事件的风险。我们从患者出院开始随访至 2018 年 12 月 31 日，以监测再次发生的 CVD 事件，包括冠状动脉、中风和外周动脉事件。
结果
在 162730 名患者中，55.2%的患者有既往 CVD，28.3%、8.3%和 8.2%的患者分别仅患有糖尿病、CKD 和糖尿病合并 CKD。每 1000 人年发生 CVD 事件的发生率在既往 CVD 患者中为 135，在仅患有糖尿病、CKD 仅患有和糖尿病合并 CKD 的患者中分别为 110、124 和 171。与既往 CVD 患者相比，多变量调整后的 CVD 事件再发风险比为 0.92（95%CI 0.90-0.95）、0.89（95%CI：0.85-0.93）和 1.18（95%CI：1.14-1.22），分别为仅患有糖尿病、CKD 仅患有和糖尿病合并 CKD 的患者。
结论
在 MI 后，患有糖尿病合并 CKD 的成年人再次发生 CVD 事件的风险高于无糖尿病或 CKD 的既往 CVD 患者。
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