Haffner S M, Lehto S, Rönnemaa T, Pyörälä K, Laakso M
Department of Medicine, University of Texas Health Science Center at San Antonio, 78284-7873, USA.
N Engl J Med. 1998 Jul 23;339(4):229-34. doi: 10.1056/NEJM199807233390404.
Type 2 (non-insulin-dependent) diabetes is associated with a marked increase in the risk of coronary heart disease. It has been debated whether patients with diabetes who have not had myocardial infarctions should be treated as aggressively for cardiovascular risk factors as patients who have had myocardial infarctions.
To address this issue, we compared the seven-year incidence of myocardial infarction (fatal and nonfatal) among 1373 nondiabetic subjects with the incidence among 1059 diabetic subjects, all from a Finnish population-based study.
The seven-year incidence rates of myocardial infarction in nondiabetic subjects with and without prior myocardial infarction at base line were 18.8 percent and 3.5 percent, respectively (P<0.001). The seven-year incidence rates of myocardial infarction in diabetic subjects with and without prior myocardial infarction at base line were 45.0 percent and 20.2 percent, respectively (P<0.001). The hazard ratio for death from coronary heart disease for diabetic subjects without prior myocardial infarction as compared with nondiabetic subjects with prior myocardial infarction was not significantly different from 1.0 (hazard ratio, 1.4; 95 percent confidence interval, 0.7 to 2.6) after adjustment for age and sex, suggesting similar risks of infarction in the two groups. After further adjustment for total cholesterol, hypertension, and smoking, this hazard ratio remained close to 1.0 (hazard ratio, 1.2; 95 percent confidence interval, 0.6 to 2.4).
Our data suggest that diabetic patients without previous myocardial infarction have as high a risk of myocardial infarction as nondiabetic patients with previous myocardial infarction. These data provide a rationale for treating cardiovascular risk factors in diabetic patients as aggressively as in nondiabetic patients with prior myocardial infarction.
2型（非胰岛素依赖型）糖尿病与冠心病风险显著增加相关。对于未曾发生心肌梗死的糖尿病患者，是否应像发生过心肌梗死的患者一样积极治疗心血管危险因素，一直存在争议。
为解决这一问题，我们比较了来自芬兰一项基于人群研究的1373名非糖尿病受试者与1059名糖尿病受试者中心肌梗死（致命性和非致命性）的七年发病率。
基线时无既往心肌梗死的非糖尿病受试者和有既往心肌梗死的非糖尿病受试者的七年心肌梗死发病率分别为18.8%和3.5%（P<0.001）。基线时无既往心肌梗死的糖尿病受试者和有既往心肌梗死的糖尿病受试者的七年心肌梗死发病率分别为45.0%和20.2%（P<0.001）。在对年龄和性别进行调整后，无既往心肌梗死的糖尿病受试者与有既往心肌梗死的非糖尿病受试者相比，冠心病死亡的风险比与1.0无显著差异（风险比为1.4；95%置信区间为0.7至2.6），表明两组梗死风险相似。在进一步对总胆固醇、高血压和吸烟进行调整后，该风险比仍接近1.0（风险比为1.2；95%置信区间为0.6至2.4）。
我们的数据表明，既往无心肌梗死的糖尿病患者发生心肌梗死的风险与既往有心肌梗死的非糖尿病患者一样高。这些数据为像治疗既往有心肌梗死的非糖尿病患者一样积极治疗糖尿病患者的心血管危险因素提供了理论依据。
