Barrot Joan, Real Jordi, Vlacho Bogdan, Romero-Aroca Pedro, Simó Rafael, Mauricio Didac, Mata-Cases Manel, Castelblanco Esmeralda, Mundet-Tuduri Xavier, Franch-Nadal Josep
Primary Health Care Center Dr. Jordi Nadal i Fàbregas (Salt), Gerència d'Atenció Primària, Institut Català de la Salut, Girona, Spain.
Diabetis des de l'Atenció Primária (DAP)-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGOL), Barcelona, Spain.
Front Med (Lausanne). 2022 Aug 16;9:945245. doi: 10.3389/fmed.2022.945245. eCollection 2022.
This study aimed to evaluate the predictive value of diabetic retinopathy (DR) and its stages with the incidence of major cardiovascular events and all-cause mortality in type 2 diabetes mellitus (T2DM) persons in our large primary healthcare database from Catalonia (Spain). A retrospective cohort study with pseudo-anonymized routinely collected health data from SIDIAP was conducted from 2008 to 2016. We calculated incidence rates of major cardiovascular events [coronary heart disease (CHD), stroke, or both-macrovascular events] and all-cause mortality for subjects with and without DR and for different stages of DR. The proportional hazards regression analysis was done to assess the probability of occurrence between DR and the study events. About 22,402 T2DM subjects with DR were identified in the database and 196,983 subjects without DR. During the follow-up period among the subjects with DR, we observed the highest incidence of all-cause mortally. In the second place were the macrovascular events among the subjects with DR. In the multivariable analysis, fully adjusted for DR, sex, age, body mass index (BMI), tobacco, duration of T2DM, an antiplatelet or antihypertensive drug, and HbA1c, we observed that subjects with any stage of DR had higher risks for all of the study events, except for stroke. We observed the highest probability of all-cause death events (adjusted hazard ratios, AHRs: 1.34, 95% CI: 1.28; 1.41). In conclusion, our results show that DR is related to CHD, macrovascular events, and all-cause mortality among persons with T2DM.
本研究旨在通过我们来自加泰罗尼亚（西班牙）的大型初级医疗保健数据库，评估2型糖尿病（T2DM）患者中糖尿病视网膜病变（DR）及其分期对主要心血管事件发生率和全因死亡率的预测价值。我们利用SIDIAP中常规收集的伪匿名健康数据，于2008年至2016年开展了一项回顾性队列研究。我们计算了患有和未患有DR的受试者以及不同DR分期的受试者的主要心血管事件[冠心病（CHD）、中风或两者兼有的大血管事件]发生率和全因死亡率。采用比例风险回归分析来评估DR与研究事件之间发生的概率。数据库中识别出约22402例患有DR的T2DM受试者和196983例未患有DR的受试者。在随访期间，患有DR的受试者中全因死亡率最高。其次是患有DR的受试者中的大血管事件。在多变量分析中，对DR、性别、年龄、体重指数（BMI）、吸烟、T2DM病程、抗血小板或降压药物以及糖化血红蛋白（HbA1c）进行了充分校正后，我们观察到除中风外，任何DR分期的受试者发生所有研究事件的风险均较高。我们观察到全因死亡事件的概率最高（校正风险比，AHRs：1.34，95%CI：1.28；1.41）。总之，我们的结果表明，DR与T2DM患者的CHD、大血管事件和全因死亡率相关。
