Heart failure and chronic kidney disease manifestation and mortality risk associations in type 2 diabetes: A large multinational cohort study
Heart failure and chronic kidney disease manifestation and mortality risk associations in type 2 diabetes: A large multinational cohort study
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DOI：
10.1111/dom.14074
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发表时间：
2020-06-03
影响因子：
5.8
通讯作者：
Kadowaki, Takashi
中科院分区：
文献类型：
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作者：
Birkeland, Kare, I;Bodegard, Johan;Kadowaki, Takashi
目的 检查最初没有 CVRD 的 2 型糖尿病 (T2D) 患者的心血管或肾脏疾病 (CVRD) 表现以及与这些疾病相关的死亡风险。 方法从英国、德国、日本、荷兰、挪威和瑞典在固定日期的医疗记录中识别出没有 CVRD 的患者。 CVRD 表现的定义是首次诊断出心肾疾病、中风、心肌梗塞 (MI) 或外周动脉疾病 (PAD) 事件。将与心力衰竭 (HF)、慢性肾病 (CKD)、MI、卒中或 PAD 单一 CVRD 病史相关的死亡风险与无 CVRD 状态相关的死亡风险进行比较。结果 在 1 177 896 名 T2D 患者中，772 336 名 (66%) 没有 CVRD，并平均随访 4.5 年。共有 137 081 名患者（18%）出现首次 CVRD 表现，包括 CKD（36%）、HF（24%）、卒中（16%）、MI（14%）和 PAD（10%）。 HF 或 CKD 与心血管和全因死亡风险增加相关：风险比 (HR) 分别为 2.02（95% 置信区间 [CI] 1.75-2.33）和 HR 2.05（95% CI 1.82-2.32）。 HF 和 CKD 分别与显着增加的死亡风险相关，而两者的组合与最高的心血管和全因死亡风险相关：HR 分别为 3.91 (95% CI 3.02-5.07) 和 3.14 (95% CI 2.90-3.40)。 始终是最常见的首发心血管疾病表现，并且还与死亡风险增加相关。这些新发现表明这些心肾疾病是重要且严重的并发症，需要改进的预防策略。
Aims To examine the manifestation of cardiovascular or renal disease (CVRD) in patients with type 2 diabetes (T2D) initially free from CVRD as well as the mortality risks associated with these diseases.Methods Patients free from CVRD were identified from healthcare records in England, Germany, Japan, the Netherlands, Norway and Sweden at a fixed date. CVRD manifestation was defined by first diagnosis of cardiorenal disease, or a stroke, myocardial infarction (MI) or peripheral artery disease (PAD) event. The mortality risk associated with single CVRD history of heart failure (HF), chronic kidney disease (CKD), MI, stroke or PAD was compared with that associated with CVRD-free status.Results Of 1 177 896 patients with T2D, 772 336 (66%) were CVRD-free and followed for a mean of 4.5 years. A total of 137 081 patients (18%) developed a first CVRD manifestation, represented by CKD (36%), HF (24%), stroke (16%), MI (14%) and PAD (10%). HF or CKD was associated with increased cardiovascular and all-cause mortality risk: hazard ratio (HR) 2.02 (95% confidence interval [CI] 1.75-2.33) and HR 2.05 (95% CI 1.82-2.32), respectively. HF and CKD were separately associated with significantly increased mortality risks, and the combination was associated with the highest cardiovascular and all-cause mortality risk: HRs 3.91 (95% CI 3.02-5.07) and 3.14 (95% CI 2.90-3.40), respectively.Conclusion In a large multinational study of >750 000 CVRD-free patients with T2D, HF and CKD were consistently the most frequent first cardiovascular disease manifestations and were also associated with increased mortality risks. These novel findings show these cardiorenal diseases to be important and serious complications requiring improved preventive strategies.