Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark; Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
J Am Coll Cardiol. 2024 Dec 3;84(23):2251-2259. doi: 10.1016/j.jacc.2024.06.050.
The risk of cardiovascular disease (CVD) is increased in individuals with type 2 diabetes mellitus (T2DM), but it remains uncertain how long an elevated CVD occurrence precedes diabetes diagnosis.
The aim of this study was to investigate CVD occurrence 30 years before, and 5 years after, T2DM diagnosis compared with matched comparisons.
This combined case-control and cohort study included all individuals diagnosed with T2DM in Denmark between 2010 and 2015, as well as general population comparisons matched by age and sex. CVD was defined as myocardial infarction or ischemic stroke. Conditional logistic regression was used to compute ORs for CVD prevalence in the 30-year period before T2DM diagnosis. Cox proportional hazards regression models were used to compute HRs for 5-year CVD incidence after T2DM diagnosis.
The study included 127,092 individuals with T2DM and 381,023 matched comparisons. In the 30-year period before T2DM diagnosis, 14,179 (11.2%) T2DM individuals and 17,871 (4.7%) comparisons experienced CVD. CVD prevalence was higher in those with T2DM than the comparisons in the entire period before T2DM diagnosis, with ORs ranging from 2.18 (95% CI: 1.91-2.48) in the earliest period (25-30 years before diagnosis) to 2.96 (95% CI: 2.85-3.08) in the latest period (<5 years before diagnosis). After T2DM diagnosis, 5-year CVD incidence was similarly increased in T2DM individuals vs comparisons (HR: 2.20; 95% CI: 2.12-2.27).
Individuals with T2DM had 2-fold more CVD events than matched comparisons starting 3 decades before T2DM diagnosis. This indicates that comprehensive preventive strategies may be initiated much earlier in individuals at risk of T2DM.
2 型糖尿病（T2DM）患者发生心血管疾病（CVD）的风险增加，但尚不清楚 CVD 的发生时间早于糖尿病诊断多长时间。
本研究旨在调查 T2DM 诊断前 30 年和诊断后 5 年与匹配对照相比 CVD 的发生情况。
本项病例对照和队列研究纳入了 2010 年至 2015 年期间在丹麦被诊断为 T2DM 的所有患者以及年龄和性别相匹配的一般人群对照。CVD 定义为心肌梗死或缺血性卒中。采用条件 logistic 回归计算 T2DM 诊断前 30 年 CVD 患病率的比值比（OR）。采用 Cox 比例风险回归模型计算 T2DM 诊断后 5 年 CVD 发生率的 HR。
本研究共纳入了 127092 例 T2DM 患者和 381023 例匹配对照。在 T2DM 诊断前 30 年期间，14179 例（11.2%）T2DM 患者和 17871 例（4.7%）对照发生了 CVD。在整个 T2DM 诊断前期间，T2DM 患者的 CVD 患病率均高于对照，OR 范围从最早时期（诊断前 25-30 年）的 2.18（95%CI：1.91-2.48）到最晚时期（<5 年）的 2.96（95%CI：2.85-3.08）。在 T2DM 诊断后，T2DM 患者与对照相比，5 年 CVD 发生率也明显增加（HR：2.20；95%CI：2.12-2.27）。
T2DM 患者在 T2DM 诊断前 30 年就发生 CVD 的风险是匹配对照的 2 倍。这表明在 2 型糖尿病高危人群中，可能更早启动综合预防策略。
