Krolewski A S, Kosinski E J, Warram J H, Leland O S, Busick E J, Asmal A C, Rand L I, Christlieb A R, Bradley R F, Kahn C R
Am J Cardiol. 1987 Apr 1;59(8):750-5. doi: 10.1016/0002-9149(87)91086-1.
The risk of premature coronary artery disease (CAD) and its determinants were investigated in a cohort of 292 patients with juvenile-onset, insulin-dependent diabetes mellitus (IDDM) who were followed for 20 to 40 years. Although patients with juvenile-onset IDDM had an extremely high risk of premature CAD, the earliest deaths due to CAD did not occur until late in the third decade of life. After age 30 years, the mortality rate due to CAD increased rapidly, equally in men and women, and particularly among persons with renal complications. By age 55 years the cumulative mortality rate due to CAD was 35 +/- 5%. This was far higher than the corresponding rate for nondiabetic persons in the Framingham Heart Study, 8% for men and 4% for women. Angina and acute nonfatal myocardial infarction followed a similar pattern, as did asymptomatic CAD detected by stress test, so that their combined prevalence rate was 33% among survivors aged 45 to 59 years. Age at onset of IDDM and the presence of eye complications did not contribute to risk of premature CAD. This pattern suggests that juvenile-onset diabetes and its renal complications are modifiers of the natural history of atherosclerosis in that although they profoundly accelerate progression of early atherosclerotic lesions to very severe CAD, they may not contribute to initiation of atherosclerosis.
在一组292例青少年起病的胰岛素依赖型糖尿病（IDDM）患者中，对早发冠状动脉疾病（CAD）的风险及其决定因素进行了长达20至40年的随访研究。尽管青少年起病的IDDM患者早发CAD的风险极高，但最早因CAD导致的死亡直到生命的第三个十年后期才出现。30岁以后，CAD导致的死亡率迅速上升，男性和女性相同，特别是在有肾脏并发症的人群中。到55岁时，CAD导致的累积死亡率为35±5%。这远高于弗明汉心脏研究中无糖尿病者的相应死亡率，男性为8%，女性为4%。心绞痛和急性非致命性心肌梗死呈现类似模式，通过应激试验检测到的无症状CAD也是如此，因此在45至59岁的幸存者中，它们的合并患病率为33%。IDDM起病年龄和眼部并发症的存在对早发CAD的风险没有影响。这种模式表明，青少年起病的糖尿病及其肾脏并发症是动脉粥样硬化自然史的调节因素，因为尽管它们会极大地加速早期动脉粥样硬化病变发展为非常严重的CAD，但可能不会促成动脉粥样硬化的起始。
