阿司匹林治疗对非胰岛素依赖型糖尿病合并冠心病患者生存率的影响。以色列苯扎贝特心肌梗死预防研究组。

Effects of aspirin treatment on survival in non-insulin-dependent diabetic patients with coronary artery disease. Israeli Bezafibrate Infarction Prevention Study Group.

作者信息

Harpaz D, Gottlieb S, Graff E, Boyko V, Kishon Y, Behar S

机构信息

Heart Institute, E. Wolfson Medical Center, Holon, Israel.

出版信息

Am J Med. 1998 Dec;105(6):494-9. doi: 10.1016/s0002-9343(98)00328-3.

DOI:10.1016/s0002-9343(98)00328-3

PMID:9870835

Abstract

PURPOSE

The benefit of aspirin treatment among diabetic patients with chronic coronary artery disease is not well established. The purpose of this study was to assess the effect of aspirin on cardiac and total mortality in a large cohort of diabetic patients with established coronary artery disease and to compare it with the effect of aspirin in nondiabetic counterparts.

PATIENTS AND METHODS

In this observational study among patients screened for participation in the Bezafibrate Infarction Prevention Study, the effects of aspirin treatment in 2,368 non-insulin-dependent diabetic patients with coronary artery disease were compared to those in 8,586 nondiabetic patients. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated with proportional hazards models.

RESULTS

Fifty-two percent of diabetic patients and 56% of nondiabetic patients reported aspirin therapy. After 5.1 +/- 1.3 (mean +/- SD) years of follow-up, the absolute benefit per 100 patients treated with aspirin was greater in diabetic patients than in nondiabetic patients (cardiac mortality benefit: 5.0 versus 2.1, and all-cause mortality benefit: 7.8 versus 4.1). Overall cardiac mortality among diabetic patients treated with aspirin was 10.9% versus 15.9% in the nonaspirin group (P < 0.001), and all-cause mortality was 18.4% and 26.2% (P < 0.001). After adjustment for possible confounders, treatment with aspirin was an independent predictor of reduced overall cardiac (HR = 0.8; 95% CI: 0.6-1.0) and all-cause mortality (HR = 0.8; 95% CI: 0.7-0.9) among diabetic patients, similar to those in nondiabetic patients.

CONCLUSION

Treatment with aspirin was associated with a significant reduction in cardiac and total mortality among non-insulin-dependent diabetic patients with coronary artery disease. The absolute benefit of aspirin was greater in diabetic patients than in those without diabetes.

摘要

目的

阿司匹林治疗对患有慢性冠状动脉疾病的糖尿病患者的益处尚未明确确立。本研究的目的是评估阿司匹林对一大群已确诊冠状动脉疾病的糖尿病患者心脏和全因死亡率的影响，并将其与阿司匹林对非糖尿病患者的影响进行比较。

患者与方法

在这项针对筛选参与苯扎贝特心肌梗死预防研究的患者的观察性研究中，比较了2368例非胰岛素依赖型冠状动脉疾病糖尿病患者与8586例非糖尿病患者中阿司匹林治疗的效果。采用比例风险模型估计风险比（HR）和95%置信区间（CI）。

结果

52%的糖尿病患者和56%的非糖尿病患者报告接受了阿司匹林治疗。经过5.1±1.3（均值±标准差）年的随访，每100例接受阿司匹林治疗的患者中，糖尿病患者的绝对获益大于非糖尿病患者（心脏死亡率获益：5.0对2.1，全因死亡率获益：7.8对4.1）。接受阿司匹林治疗的糖尿病患者总体心脏死亡率为10.9%，而非阿司匹林治疗组为15.9%（P<0.001），全因死亡率分别为18.4%和26.2%（P<0.001）。在对可能的混杂因素进行调整后，阿司匹林治疗是糖尿病患者总体心脏（HR=0.8；95%CI：0.6 - 1.0）和全因死亡率降低的独立预测因素，与非糖尿病患者相似。