A PROSPECTIVE-STUDY OF MATURITY-ONSET DIABETES-MELLITUS AND RISK OF CORONARY HEART-DISEASE AND STROKE IN WOMEN
A PROSPECTIVE-STUDY OF MATURITY-ONSET DIABETES-MELLITUS AND RISK OF CORONARY HEART-DISEASE AND STROKE IN WOMEN
复制标题
DOI：
10.1001/archinte.151.6.1141
复制
发表时间：
1991-06-01
影响因子：
--
通讯作者：
HENNEKENS, CH
中科院分区：
文献类型：
--
作者：
MANSON, JE;COLDITZ, GA;HENNEKENS, CH
我们在1976年对116177名年龄在30 - 55岁之间、无已知冠心病、中风和癌症的美国女性进行了队列研究，研究了成熟期临床糖尿病与随后冠心病、中风、总心血管死亡率和全因死亡率的关系。 在8年的随访（889255人年）中，我们确定了338例非致命性心肌梗死，111例冠状动脉死亡，259例中风，238例心血管死亡和1349例全因死亡。 糖尿病与非致命性心肌梗死和致命性冠心病的风险显著增加相关（年龄校正的相对风险[RR] = 6.7; 95%置信区间[Cl]，5.3 - 8.4），缺血性卒中（RR = 5.4; 95%CI，3.3至9.0）、总心血管死亡率（RR = 6.3; 95%CI，4.6至8.6）和全因死亡率（RR = 3.0; 95%CI，2.5至3.7）。 在同时控制其他已知的冠状动脉危险因素后，糖尿病的主要独立效应在多变量分析中持续存在（对于这些终点，RR [95% CI]分别为3.1 [2.3 - 4.2]、3.0 [1.6 - 5.7]、3.0 [1.9 - 4.8]和1.9 [1.4 - 2.4]）。 在存在其他危险因素的情况下，包括吸烟、高血压和肥胖，糖尿病引起的绝对过量冠状动脉风险更大。 这些前瞻性数据表明，成熟期临床糖尿病是中年女性冠心病、缺血性卒中和心血管死亡率的重要决定因素。 糖尿病的不良影响在其他心血管危险因素的存在下被放大，其中许多是可以改变的。
We examined the relationship of maturity-onset clinical diabetes mellitus with the subsequent incidence of coronary heart disease, stroke, total cardiovascular mortality, and all-cause mortality in a cohort of 116 177 US women who were 30 to 55 years of age and free of known coronary heart disease, stroke, and cancer in 1976. During 8 years of follow-up (889 255 person-years), we identified 338 nonfatal myocardial infarctions, 111 coronary deaths, 259 strokes, 238 cardiovascular deaths, and 1349 deaths from all causes. Diabetes was associated with a markedly increased risk of nonfatal myocardial infarction and fatal coronary heart disease (age-adjusted relative risk [RR] = 6.7; 95% confidence interval [Cl], 5.3 to 8.4), ischemic stroke (RR = 5.4; 95% Cl, 3.3 to 9.0), total cardiovascular mortality (RR = 6.3; 95% Cl, 4.6 to 8.6), and all-cause mortality (RR = 3.0; 95% Cl, 2.5 to 3.7). A major independent effect of diabetes persisted in multivariate analyses after simultaneous control for other known coronary risk factors (for these end points, RR [95% Cl] = 3.1 [2.3 to 4.2], 3.0 [1.6 to 5.7], 3.0 [1.9 to 4.8], and 1.9 [1.4 to 2.4], respectively). The absolute excess coronary risk due to diabetes was greater in the presence of other risk factors, including cigarette smoking, hypertension, and obesity. These prospective data indicate that maturity-onset clinical diabetes is a strong determinant of coronary heart disease, ischemic stroke, and cardiovascular mortality among middle-aged women. The adverse effect of diabetes is amplified in the presence of other cardiovascular risk factors, many of which are modifiable.