Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
Diabetes Care. 2022 Sep 1;45(9):2144-2151. doi: 10.2337/dc22-0440.
We examined temporal trends in risk of first-time ischemic stroke in patients with incident type 2 diabetes mellitus (T2DM) and no prior atherosclerotic cardiovascular disease (ASCVD).
Using nationwide health registries, we identified all patients with incident T2DM without a prior hospital diagnosis of ASCVD from 1996 to 2015 in Denmark. Patients were assigned to 5-year periods based on the date of T2DM diagnosis and were followed for 5 years. Each patient was matched by sex and age with up to three individuals from the general population. Temporal trends in ischemic stroke were examined using Cox regression to compute hazard ratios (HRs). Temporal use of prophylactic cardiovascular medications was also assessed.
The study comprised 288,825 patients with incident T2DM and 782,232 general population individuals. From 1996-2000 to 2011-2015, the 5-year risk of first-time ischemic stroke was approximately halved in the T2DM cohort (5.2% vs. 2.7%; sex- and age-adjusted HR 0.52 [95% CI 0.49-0.55]). Patients diagnosed in 2011-2015 had increased risk of ischemic stroke compared with individuals in the general population; however, the risk difference narrowed over time (5.2% vs. 2.9% in 1996-1999 [difference 2.3%]; 2.7% vs. 2.0% in 2011-2015 [difference 0.7%]). Use of prophylactic cardiovascular medications increased markedly during the overall study period, especially use of statins (from 5% to 50%) and multiple antihypertensive drugs (from 18% to 33%).
From 1996 to 2015, the 5-year risk of first-time ischemic stroke was approximately halved in patients with incident T2DM and no prior ASCVD, coinciding with markedly increased use of prophylactic cardiovascular medications.
我们研究了初发 2 型糖尿病（T2DM）且无既往动脉粥样硬化性心血管疾病（ASCVD）患者首次发生缺血性卒中的风险随时间的变化趋势。
利用全国性健康登记系统，我们从 1996 年至 2015 年在丹麦确定了所有初发 T2DM 且既往无 ASCVD 住院诊断的患者。患者根据 T2DM 诊断日期分为 5 年时间段，并随访 5 年。每位患者按照性别和年龄与普通人群中最多 3 人进行匹配。使用 Cox 回归计算风险比（HR）来评估缺血性卒中的时间趋势。还评估了预防性心血管药物的时间使用情况。
这项研究纳入了 288825 例初发 T2DM 患者和 782232 例普通人群个体。1996-2000 年至 2011-2015 年，T2DM 队列中首次发生缺血性卒中的 5 年风险降低了近一半（5.2% vs. 2.7%；性别和年龄校正 HR 0.52 [95%CI 0.49-0.55]）。2011-2015 年诊断的患者发生缺血性卒中的风险高于普通人群个体；然而，风险差异随时间缩小（1996-1999 年为 5.2% vs. 2.9%[差异 2.3%]；2011-2015 年为 2.7% vs. 2.0%[差异 0.7%]）。整个研究期间，预防性心血管药物的使用显著增加，尤其是他汀类药物（从 5%增至 50%）和多种降压药物（从 18%增至 33%）。
1996 年至 2015 年，初发 T2DM 且无既往 ASCVD 的患者首次发生缺血性卒中的 5 年风险降低了近一半，这与预防性心血管药物的使用显著增加有关。
