The impact of diabetes mellitus on mortality from all causes and coronary heart disease in women - 20 years of follow-up
The impact of diabetes mellitus on mortality from all causes and coronary heart disease in women - 20 years of follow-up
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DOI：
10.1001/archinte.161.14.1717
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发表时间：
2001-07-23
影响因子：
--
通讯作者：
Manson, JE
中科院分区：
文献类型：
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作者：
Hu, FB;Stampfer, MJ;Manson, JE
背景：关于 2 型糖尿病对女性总死亡率和致命性冠心病 (CHD) 的长期影响，目前的数据很少。 方法：我们前瞻性地研究了 2 型糖尿病和既往 CHD 病史对护士健康研究中 121046 名 30 至 55 岁患有 2 型糖尿病的女性全因死亡率和 CHD 的影响，这些女性从 1976 年到 20 年间进行了 20 年的随访。 1996. 结果：在 20 年的跟踪调查中，我们记录了 8464 例因各种原因死亡的病例，其中包括 1239 例致命的 CHD 事件。与基线时没有糖尿病或 CHD 的女性相比，基线时有糖尿病病史且无 CHD 的女性总体死亡率的年龄调整相对风险 (RR) 为 3.39（95% CI，3.08-3.73），基线时有 CHD 病史且无糖尿病的女性为 3.00（95% CI，2.50-3.60），以及 6.84（95% CI， 4.71-9.95）对于基线时患有这两种疾病的女性。这 4 组致命性 CHD 的相应年龄调整 RR 分别为 1.0、8.70、10.6 和 24.8。对体重指数和其他冠状动脉危险因素进行的多变量调整仅适度减弱了 RR。与非糖尿病患者相比，不同糖尿病病程类别（小于或等于 5、6-10、11-15、16-25、> 25 年）致命性 CHD 的多变量 RR 分别为 2.75、.3.63、5.51、6.38 和 11.9（趋势 P < .001）。既往 CHD 和长期临床糖尿病关系（> 15 年）相结合，致死性 CHD 风险增加 30 倍（95% CI，20.7-43.5）。结论：我们的数据表明，在女性中，糖尿病史与全因死亡和致死性 CHD 风险显着增加相关。 ：糖尿病和既往冠心病的结合可识别出特别高风险的女性。
Background: Few data are available on the long-term impact of type 2 diabetes mellitus on total mortality and fatal coronary heart disease (CHD) in women.Methods: We examined prospectively the impact of type 2 diabetes and history of prior CHD on mortality from all causes and CHD among 121046 women aged 30 to 55 years with type 2 diabetes in the Nurses' Health Study who were followed up for 20 years from 1976 to 1996.Results: During 20 years of follow-up, we documented 8464 deaths from all causes, including 1239 fatal CHD events. Compared with women with no diabetes or CHD at baseline, age-adjusted relative risks (RRs) of overall mortality were 3.39 (95% confidence interval [CI], 3.08-3.73) for women with a history of diabetes and no CHD at baseline, 3.00 (95% CI, 2.50-3.60) for women with a history of CHD and no diabetes at baseline, and 6.84 (95% CI, 4.71-9.95) for women with both conditions at base- line. The corresponding age-adjusted RRs of fatal CHD across these 4 groups were 1.0, 8.70, 10.6, and 24.8, respectively. Multivariate adjustment for body mass index and other coronary risk factors only modestly attenuated the RRs. Compared with nondiabetic persons, the multivariate RRs of fatal CHD across categories of diabetes duration (less than or equal to5, 6-10, 11-15, 16-25, > 25 years) were 2.75,.3.63, 5.51, 6.38, and 11.9 (P < .001 for trend), respectively. The combination of prior CHD and a long duration of clinical diabetes tie, > 15 years) was associated with a 30-fold (95% CI, 20.7-43.5) increased risk of fatal CHD.Conclusions: Our data indicate that among women, history of diabetes is associated with dramatically increased risks of death from all causes and fatal CHD. :The combination of diabetes and prior CHD identifies particularly high-risk women.