Similar decline in mortality rate of older persons with and without type 2 diabetes between 1993 and 2004 the Icelandic population-based Reykjavik and AGES-Reykjavik cohort studies
Similar decline in mortality rate of older persons with and without type 2 diabetes between 1993 and 2004 the Icelandic population-based Reykjavik and AGES-Reykjavik cohort studies
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DOI：
10.1186/1471-2458-13-36
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发表时间：
2013-01-15
影响因子：
4.5
通讯作者：
Gudnason, Vilmundur
中科院分区：
文献类型：
--
作者：
Olafsdottir, Elin;Aspelund, Thor;Gudnason, Vilmundur
背景：近几十年来，心血管疾病死亡率和全因死亡率的下降导致西方世界的预期寿命增加。与此同时，2型糖尿病的患病率一直在上升，这是一种与心血管疾病和死亡率的双重超额风险相关的疾病。这项研究的目的是评估两个基于人群的老年队列中心血管和全原因死亡率的长期趋势，其中患有和不患有2型糖尿病的老年人分别接受11年的检查。方法：来自基于人群的雷克雅未克研究的1506名参与者(42%的男性)在1991-1996年(1993年的中位数)进行检查，平均年龄75.0岁，以及4814名参与者(43%的男性)在2002-2006年(2004年的中位数)进行检查，平均年龄77.2岁，年龄范围在两个队列70-87岁。主要观察指标是在连续两个5.7年和5.3年的随访期内，因心血管疾病和各种原因导致的年龄别死亡率。结果：在1993-2004年间，心血管疾病死亡率下降了32%，全原因死亡率下降了19%。2型糖尿病患者的降幅更大，糖尿病患者与非糖尿病患者相比，心血管死亡率的调整风险比从1993年的1.88(95%可信区间1.24-2.85)下降到2004年的1.46(95%可信区间1.11-1.91)。我们还观察到，在患有和不患有糖尿病的患者中，主要心血管危险因素同时减少。2004年糖尿病患者接受降糖、高血压和降脂药物治疗的比例较高。结论：在1993-2004年间，无论是否患有2型糖尿病，老年人群的心血管和全因死亡率均呈下降趋势。这一下降的部分原因可能是在研究期间心血管危险因素和医疗治疗的改善。然而，2型糖尿病仍然是心血管死亡的独立危险因素。
Background: A decline in mortality rates due to cardiovascular diseases and all-cause mortality has led to increased life expectancy in the Western world in recent decades. At the same time, the prevalence of type 2 diabetes, a disease associated with a twofold excess risk of cardiovascular disease and mortality, has been increasing. The objective of this study was to estimate the secular trend of cardiovascular and all-cause mortality rates in two population-based cohorts of older persons, with and without type 2 diabetes, examined 11 years apart.Methods: 1506 participants (42% men) from the population-based Reykjavik Study, examined during 1991-1996 (median 1993), mean age 75.0 years, and 4814 participants (43% men) from the AGES-Reykjavik Study, examined during 2002-2006 (median 2004), mean age 77.2 years, age range in both cohorts 70-87 years. The main outcome measures were age-specific mortality rates due to cardiovascular disease and all causes, over two consecutive 5.7- and 5.3-year follow-up periods.Results: A 32% decline in cardiovascular mortality rate and a 19% decline in all-cause mortality rate were observed between 1993 and 2004. The decline was greater in those with type 2 diabetes, as illustrated by the decline in the adjusted hazard ratio of cardiovascular mortality in individuals with diabetes compared to those without diabetes, from 1.88 (95% CI 1.24-2.85) in 1993 to 1.46 (95% CI 1.11-1.91) in 2004. We also observed a concurrent decrease in major cardiovascular risk factors in both those with and without diabetes. A higher proportion of persons with diabetes received glucose-lowering, hypertensive and lipid-lowering medication in 2004.Conclusions: A decline in cardiovascular and all-cause mortality rates was observed in older persons during the period 1993-2004, in both those with and without type 2 diabetes. This decline may be partly explained by improvements in cardiovascular risk factors and medical treatment over the period studied. However, type 2 diabetes still persists as an independent risk factor for cardiovascular mortality.