Rawshani Araz, Eliasson Björn, Boren Jan, Sattar Naveed, Bhatt Deepak, El-Khalili Linn, Nordanstig Joakim, Avdic Tarik, Beckman Joshua A, Gerstein Hertzel C, McGuire Darren K, Omerovic Elmir, Rawshani Aidin
Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sweden.
Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine, University of Gothenburg, Sweden.
Lancet Reg Health Eur. 2024 Mar 19;39:100888. doi: 10.1016/j.lanepe.2024.100888. eCollection 2024 Apr.
Few studies have explored long-term trends and risk factors for peripheral arterial complications in type 2 diabetes compared to the general population. Our research focuses on identifying optimal risk factors, their significance, risk associated with multifactorial risk factor control, and trends for these complications in diabetic patients versus general controls.
This study included persons with type 2 diabetes mellitus entered into the Swedish National Diabetes Register 2001-2019 and controls matched for age-, sex- and county of residence. Outcomes comprised of extracranial large artery disease, aortic aneurysm, aortic dissection, lower extremity arterial disease and diabetes foot disease. Standardized incidence rates and Cox regression were used for analyses.
The study comprises 655,250 persons with type 2 diabetes mellitus; average age 64.2; 43.8% women. Among persons with type 2 diabetes mellitus, the incidence rates per 100,000 person years for each non-coronary peripheral arterial complication event changed between 2001 and 2019 as follows: extracranial large artery disease 170.0-84.9; aortic aneurysm 40.6-69.2; aortic dissection 9.3 to 5.6; lower extremity artery disease from 338.8 to 190.8; and diabetic foot disease from 309.8 to 226.8. Baseline hemoglobin A1c (HbA1c), systolic blood pressure (SBP), smoking status and lipid levels were independently associated with all outcomes in the type 2 diabetes mellitus cohort. Within the cohort with type 2 diabetes mellitus, the risk for extracranial large artery disease and lower extremity artery disease increased in a stepwise fashion for each risk factor not within target. Excess risk for non-coronary peripheral arterial complications in the entire cohort for persons with type 2 diabetes mellitus, compared to matched controls, were as follows: extracranial large artery disease adjusted hazard ratio (HR) 1.69 (95% confidence interval (CI), 1.65-1.73), aortic aneurysm HR 0.89 (95% CI, 0.87-0.92), aortic dissection HR 0.51 (95% CI, 0.46-0.57) and lower extremity artery disease HR 2.59 (95% CI, 2.55-2.64).
The incidence of non-coronary peripheral arterial complications has declined significantly among persons with type 2 diabetes mellitus, with the exception of aortic aneurysm. HbA1c, smoking and blood pressure demonstrated greatest relative contribution for outcomes and lower levels of cardiometabolic risk factors are associated with reduced relative risk of outcomes.
Swedish Governmental and the County support of research and education of doctors, the Swedish Heart-Lung Foundation and Åke-Wibergs grant.
与普通人群相比，很少有研究探讨2型糖尿病患者外周动脉并发症的长期趋势和危险因素。我们的研究重点是确定最佳危险因素、其重要性、多因素危险因素控制相关的风险，以及糖尿病患者与普通对照人群中这些并发症的趋势。
本研究纳入了2001年至2019年进入瑞典国家糖尿病登记系统的2型糖尿病患者，以及年龄、性别和居住县相匹配的对照人群。结局包括颅外大动脉疾病、主动脉瘤、主动脉夹层、下肢动脉疾病和糖尿病足病。采用标准化发病率和Cox回归进行分析。
该研究包括655250名2型糖尿病患者；平均年龄64.2岁；女性占43.8%。在2型糖尿病患者中，2001年至2019年期间每10万人年各非冠状动脉外周动脉并发症事件的发病率变化如下：颅外大动脉疾病从170.0降至84.9；主动脉瘤从40.6升至69.2；主动脉夹层从9.3降至5.6；下肢动脉疾病从338.8降至190.8；糖尿病足病从309.8降至226.8。基线糖化血红蛋白（HbA1c）、收缩压（SBP）、吸烟状况和血脂水平与2型糖尿病队列中的所有结局均独立相关。在2型糖尿病队列中，未达目标的每个危险因素都会使颅外大动脉疾病和下肢动脉疾病的风险逐步增加。与匹配的对照人群相比，2型糖尿病患者整个队列中非冠状动脉外周动脉并发症的超额风险如下：颅外大动脉疾病调整后危险比（HR）为1.69（95%置信区间（CI），1.65 - 1.73），主动脉瘤HR为0.89（95% CI，0.87 - 0.92），主动脉夹层HR为0.51（95% CI，0.46 - 0.57），下肢动脉疾病HR为2.59（95% CI，2.55 - 2.64）。
2型糖尿病患者中非冠状动脉外周动脉并发症的发病率显著下降，但主动脉瘤除外。HbA1c、吸烟和血压对结局的相对贡献最大，且较低水平的心血管代谢危险因素与较低的结局相对风险相关。
瑞典政府及县对医生研究和教育的支持、瑞典心肺基金会和阿克·维伯格基金。
