Tuomilehto J, Borch-Johnsen K, Molarius A, Forsén T, Rastenyte D, Sarti C, Reunanen A
Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland.
Diabetologia. 1998 Jul;41(7):784-90. doi: 10.1007/s001250050988.
This study evaluates the impact of diabetic nephropathy on the incidence of coronary heart disease, stroke and any cardiovascular disease in the Finnish population, which has a high risk of Type 1 (insulin-dependent) diabetes mellitus and cardiovascular disease. We performed a prospective analysis of the incidence of coronary heart disease, stroke and cardiovascular disease in all Type 1 subjects in the Finnish Type I diabetes mellitus register diagnosed before the age of 18 years between 1 January 1965 and 31 December 1979 nationwide. The effect of age at onset of diabetes, attained age at the end of follow-up, sex, diabetes duration and of the presence of diabetic nephropathy on the risk for cardiovascular disease was evaluated. Cases of nephropathy, coronary heart disease, stroke and all cardiovascular diseases were ascertained from the nationwide Finnish Hospital Discharge Register and National Death Register using computer linkage with the Type I diabetes mellitus register. Of the 5148 Type 1 diabetic patients followed up, 159 had a cardiovascular event of which 58 were coronary heart diseases, 57 stroke events and 44 other heart diseases. There were virtually no cases of cardiovascular disease before 12 years diabetes duration. The cumulative incidence of cardiovascular disease by the age of 40 years was 43% in Type 1 diabetic patients with diabetic nephropathy, compared with 7% in patients without diabetic nephropathy, similarly in men and women. The relative risk for Type 1 diabetic patients with diabetic nephropathy compared with patients without diabetic nephropathy was 10.3 for coronary heart disease, 10.9 for stroke and 10.0 for any cardiovascular disease, similarly in men and women. The presence of nephropathy in Type I diabetic subjects increases not only the risk of coronary heart disease, but also of stroke by tenfold.
本研究评估了糖尿病肾病对芬兰人群冠心病、中风及任何心血管疾病发病率的影响，芬兰人群患1型（胰岛素依赖型）糖尿病和心血管疾病的风险较高。我们对1965年1月1日至1979年12月31日期间在全国范围内18岁之前被诊断为1型糖尿病的芬兰1型糖尿病登记册中的所有受试者的冠心病、中风和心血管疾病发病率进行了前瞻性分析。评估了糖尿病发病年龄、随访结束时达到的年龄、性别、糖尿病病程以及糖尿病肾病的存在对心血管疾病风险的影响。通过将芬兰医院出院登记册和国家死亡登记册与1型糖尿病登记册进行计算机链接，确定了肾病、冠心病、中风和所有心血管疾病的病例。在随访的5148名1型糖尿病患者中，159人发生了心血管事件，其中58例为冠心病，57例为中风事件，44例为其他心脏病。糖尿病病程在12年之前几乎没有心血管疾病病例。1型糖尿病肾病患者40岁时心血管疾病的累积发病率为43%，而无糖尿病肾病患者为7%，男性和女性情况相似。与无糖尿病肾病的患者相比，1型糖尿病肾病患者患冠心病的相对风险为10.3，中风为10.9，任何心血管疾病为10.0，男性和女性情况相似。1型糖尿病患者中肾病的存在不仅增加了患冠心病的风险，还使中风风险增加了10倍。
