2 型糖尿病患者的微血管疾病和心血管结局。
Microvascular disease and cardiovascular outcomes among individuals with type 2 diabetes.
机构信息
Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Department of Medicine, University of Maryland Medical Center, Baltimore, MD, USA.
出版信息
Diabetes Res Clin Pract. 2021 Jun;176:108859. doi: 10.1016/j.diabres.2021.108859. Epub 2021 May 12.
AIM
To evaluate the associations of microvascular disease (MVD) with incident cardiovascular disease (CVD) in individuals with type 2 diabetes.
METHODS
A total of 4098 participants with type 2 diabetes and without CVD were assessed for MVD (diabetic kidney disease, retinopathy or neuropathy) in the Look AHEAD (Action for Health in Diabetes) study. Cox models were used to generate hazard ratios (HRs) for: (1) CVD composite (myocardial infarction, stroke, hospitalization for angina and/or death from cardiovascular causes), (2) coronary artery disease (CAD), (3) stroke, and (4) CVD-related deaths.
RESULTS
Of 4098 participants, 34.7% (n = 1424) had MVD at baseline. Over a median of 9.5 years, 487 developed the CVD composite, 410 CAD events, 100 stroke, and 54 CVD-related deaths. After adjusting for relevant confounders, MVD was associated with increased risks of CVD composite (HR 1.34, 95% CI 1.11-1.61), CAD (HR 1.24, 95% CI 1.01-1.52), stroke (HR 1.55, 95% CI 1.03-2.33), and cardiovascular mortality (HR 1.26, 95% CI 0.72-2.22). HRs for CVD composite by type of MVD were 1.11 (95% CI 0.89-1.38), 1.63 (95% CI 1.22-2.17) and 1.16 (95% CI 0.92-1.46) for diabetic kidney disease, retinopathy, and neuropathy, respectively.
CONCLUSIONS
Our findings underscore the relevance of MVD in CVD risk assessment in type 2 diabetes.
目的
评估微血管疾病（MVD）与 2 型糖尿病患者心血管疾病（CVD）事件的相关性。
方法
在 LOOK AHEAD（糖尿病患者健康行动）研究中，共评估了 4098 例无 CVD 的 2 型糖尿病患者的 MVD（糖尿病肾病、视网膜病变或神经病变）情况。采用 Cox 模型生成以下风险比（HR）：（1）CVD 综合（心肌梗死、中风、心绞痛住院和/或心血管原因死亡），（2）冠心病（CAD），（3）中风，和（4）CVD 相关死亡。
结果
在 4098 名参与者中，34.7%（n=1424）在基线时有 MVD。在中位数为 9.5 年的随访期间，487 人发生 CVD 综合，410 人发生 CAD 事件，100 人发生中风，54 人发生 CVD 相关死亡。在调整了相关混杂因素后，MVD 与 CVD 综合（HR 1.34，95%CI 1.11-1.61）、CAD（HR 1.24，95%CI 1.01-1.52）、中风（HR 1.55，95%CI 1.03-2.33）和心血管死亡率（HR 1.26，95%CI 0.72-2.22）的风险增加相关。按 MVD 类型划分的 CVD 综合 HR 分别为 1.11（95%CI 0.89-1.38）、1.63（95%CI 1.22-2.17）和 1.16（95%CI 0.92-1.46），分别为糖尿病肾病、视网膜病变和神经病变。
结论
我们的研究结果强调了 MVD 在 2 型糖尿病患者 CVD 风险评估中的重要性。
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