2型糖尿病患者与心力衰竭和慢性肾脏病相关的过早死亡：20年真实世界数据
Premature Mortality in Type 2 Diabetes Mellitus Associated with Heart Failure and Chronic Kidney Disease: 20 Years of Real-World Data.
作者信息
Gavina Cristina, Carvalho Daniel Seabra, Dias Daniel Martinho, Bernardo Filipa, Martinho Hugo, Couceiro João, Santos-Araújo Carla, Dinis-Oliveira Ricardo Jorge, Taveira-Gomes Tiago
机构信息
Cardiology Department, Pedro Hispano Hospital, 4464-513 Matosinhos, Portugal.
Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, 4050-313 Porto, Portugal.
出版信息
J Clin Med. 2022 Apr 11;11(8):2131. doi: 10.3390/jcm11082131.
INTRODUCTION
Type 2 diabetes mellitus (T2D) increases the risk of heart failure (HF) and chronic kidney disease (CKD). Nonetheless, evidence of cardiovascular (CV) prognosis is relatively scarce in young T2D patients.
PURPOSE
To estimate the risk of all-cause death, CV death, and non-fatal major CV events (MACEs) in T2D patients younger than 65 years old.
METHODS
We designed a retrospective cohort study using incident cases of either T2D, HF, or CKD in the population aged 40-65 years, from 1st January 2000 to 31st December 2019. Each individual was followed for up to one year. The primary analysis consisted of survival analysis with Cox proportional hazards to compare one-year risk of all-cause death, CV death, and MACEs between T2D without HF or CKD (T2D), T2D with HF (T2D-HF), and T2D with CKD (T2D-CKD) groups.
RESULTS
A total of 14,986 incident adult diabetic patients from the last two decades in our institution were included with an average age at cohort inclusion of 55-58 years old. Glycemic control was similar among groups. The adjusted hazard ratio (HR) of one-year all-cause death was 2.77 (95% CI: 2.26-3.40) for T2D-HF and 3.09 (2.77-3.45) for T2D-CKD compared with the baseline T2D risk. The highest event rate (T2D-CKD) was 0.15 per person-year. The adjusted HR of one-year CV death was 2.75 (95% CI: 2.19-3.46) for T2D-CKD and 2.59 (1.72-3.91) for T2D-HF. The non-fatal MACE risk was significantly increased in T2D-HF or T2D-CKD compared with T2D (2.82 (CI95%: 2.34-3.41) for T2D-CKD vs. 1.90 (CI95%: 1.66-2.17) for T2D-CKD) with a 32% event rate in non-fatal MACEs.
CONCLUSIONS
Coexistence of HF or CKD is associated with increased premature mortality as well as non-fatal CV events in T2D patients under 65 years old.
引言
2型糖尿病（T2D）会增加心力衰竭（HF）和慢性肾脏病（CKD）的风险。尽管如此，年轻T2D患者的心血管（CV）预后证据相对较少。
目的
评估65岁以下T2D患者的全因死亡、CV死亡和非致死性主要CV事件（MACE）风险。
方法
我们设计了一项回顾性队列研究，使用2000年1月1日至2019年12月31日期间40 - 65岁人群中T2D、HF或CKD的发病病例。对每个人随访长达一年。主要分析包括采用Cox比例风险模型进行生存分析，以比较无HF或CKD的T2D（T2D组）、合并HF的T2D（T2D - HF组）和合并CKD的T2D（T2D - CKD组）之间全因死亡、CV死亡和MACE的一年风险。
结果
我们纳入了本机构过去二十年共14986例成年糖尿病发病患者，队列纳入时的平均年龄为55 - 58岁。各组间血糖控制情况相似。与基线T2D风险相比，T2D - HF组一年全因死亡的校正风险比（HR）为2.77（95%置信区间：2.26 - 3.40），T2D - CKD组为3.09（2.77 - 3.45）。最高事件发生率（T2D - CKD组）为每人年0.15。T2D - CKD组一年CV死亡的校正HR为2.75（95%置信区间：2.19 - 3.46），T2D - HF组为2.59（1.72 - 3.91）。与T2D组相比，T2D - HF或T2D - CKD组的非致死性MACE风险显著增加（T2D - CKD组为2.82（95%置信区间：2.34 - 3.41），T2D - CKD组为1.90（95%置信区间：1.66 - 2.17）），非致死性MACE的事件发生率为32%。
结论
HF或CKD的并存与65岁以下T2D患者过早死亡率增加以及非致死性CV事件相关。
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