Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.
Department of Medicine, University of Melbourne, Fitzroy, VIC, Australia.
BMC Cardiovasc Disord. 2021 Sep 26;21(1):463. doi: 10.1186/s12872-021-02265-2.
Although it is known that patients with Type 2 Diabetes Mellitus (T2DM) are at an increased risk of coronary artery disease (CAD), the actual coronary artery burden of atherosclerotic disease in patients with and without T2DM in a real-world setting and its possible modification by preventative therapies has not been extensively documented.
Merged coronary angiography and hospital discharge data between 2013 and 2019 were obtained for analysis and a random sub-sample of patient charts were reviewed for medication use. Propensity scores were estimated using logistic regression models and used to match patients, looking at the effect of severity of CAD over time in years in an ordinal logistic regression model. A separate propensity score was estimated and used to inverse probability weight the ordinal logistic regression looking at the effect of medication use on CAD severity in patients with and without T2DM.
From 3,016 patients in the coronary angiography database, 1421 with T2DM and 1421 without T2DM were matched on propensity score. T2DM patients had more extensive CAD in 2018 compared to 2013 ((adjusted odds ratio) adjOR: 2.06 95% C.I. 1.38, 2.07), but this risk appeared to be attenuated in 2019. In contrast, there was no effect of time on CAD burden in patients without diabetes. In the sub-sample of 760 patients who underwent a chart review of their medication use, there were 367 (48%) with T2DM. For patients with T2DM 69.8% reported taking statins, 64.0% RAS inhibitors and 64.0% anti-platelet drugs. This was significantly higher than patients without diabetes of whom 46.6% reported taking statins, 49.0% RAS inhibitors and 49.9% anti-platelet drugs. As in the full matched sample, patients with diabetes had more extensive CAD (adjOR: 1.32 95% CI: 1.01, 1.74). However, after adjustment for the use of RAS inhibitors, statins and anticoagulants there was no difference in extent of CAD between patients with and without diabetes (adjOR: 1.14 95% CI: 0.85, 1.53).
Although patients with diabetes have a greater extent of CAD in comparison to those without T2DM, preventative medication use decreases this CAD burden significantly.
虽然已知 2 型糖尿病（T2DM）患者患冠状动脉疾病（CAD）的风险增加，但在真实环境中，患有和不患有 T2DM 的患者的动脉粥样硬化性疾病的实际冠状动脉负担及其可能被预防性治疗改变尚未得到广泛记录。
合并了 2013 年至 2019 年的冠状动脉造影和住院数据，对其进行分析，并对患者病历的随机子样本进行药物使用审查。使用逻辑回归模型估算倾向评分，并使用倾向评分匹配患者，使用有序逻辑回归模型观察 CAD 严重程度随时间的变化。另外，估计了一个倾向评分，并使用逆概率加权来观察 T2DM 患者和非 T2DM 患者中药物使用对 CAD 严重程度的影响。
在冠状动脉造影数据库中，对 3016 名患者进行了分析，其中 1421 名患者患有 T2DM，1421 名患者无 T2DM。在 2018 年，T2DM 患者的 CAD 更为广泛，与 2013 年相比（调整后的优势比）adjOR：2.06 95%CI：1.38，2.07），但这种风险在 2019 年似乎有所减轻。相比之下，在没有糖尿病的患者中，时间对 CAD 负担没有影响。在接受药物使用病历审查的 760 名患者的子样本中，有 367 名（48%）患有 T2DM。在患有 T2DM 的患者中，69.8%报告服用他汀类药物，64.0%报告服用肾素-血管紧张素系统抑制剂，64.0%报告服用抗血小板药物。这明显高于没有糖尿病的患者，其中 46.6%报告服用他汀类药物，49.0%报告服用肾素-血管紧张素系统抑制剂，49.9%报告服用抗血小板药物。与完整的匹配样本一样，患有糖尿病的患者的 CAD 更为广泛（adjOR：1.32 95%CI：1.01，1.74）。然而，在调整肾素-血管紧张素系统抑制剂、他汀类药物和抗凝药物的使用后，糖尿病患者与非糖尿病患者的 CAD 严重程度无差异（adjOR：1.14 95%CI：0.85，1.53）。
尽管与没有 T2DM 的患者相比，糖尿病患者的 CAD 更为广泛，但预防性药物治疗显著降低了这种 CAD 负担。
