Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes
Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes
复制标题
DOI：
10.1056/nejmoa052187
复制
发表时间：
2005-12-22
影响因子：
158.5
通讯作者：
Zinman, B
中科院分区：
文献类型：
--
作者：
Nathan, DM;Cleary, PA;Zinman, B
背景资料：强化糖尿病治疗旨在达到接近正常血糖水平，降低1型糖尿病微血管和神经系统并发症的风险。我们研究了是否使用强化治疗与传统治疗相比，在糖尿病控制和并发症试验（DCCT）影响长期心血管疾病的发病率。方法：DCCT随机分配1441例1型糖尿病患者进行强化或常规治疗，治疗他们平均为6.5年之间的1983年和1993年。在糖尿病干预和并发症的观察性流行病学研究中，93%的患者随后被随访至2005年2月1日。心血管疾病（定义为非致命性心肌梗死、中风、心血管疾病死亡、确诊的心绞痛或需要冠状动脉血运重建）采用标准化措施进行评估，并由独立委员会进行分类。在平均17年的随访中，31名在DCCT接受强化治疗的患者发生了46起心血管疾病事件，而接受常规治疗的52例患者发生了98起事件。强化治疗使任何心血管疾病事件的风险降低了42%（95%置信区间，9%至63%; P=0.02），非致命性心肌梗死、中风或心血管疾病死亡的风险降低了57%（95%置信区间，12%至79%; P=0.02）。DCCT期间糖化血红蛋白值的降低与强化治疗对心血管疾病风险的大多数积极影响显著相关。微量白蛋白尿和白蛋白尿与心血管疾病风险显着增加相关，但在调整这些因素后，治疗组之间的差异仍然显着（P </等于0.05）。结论：强化糖尿病治疗对心血管疾病的风险具有长期有益影响1型糖尿病患者的疾病。
Background: Intensive diabetes therapy aimed at achieving near normoglycemia reduces the risk of microvascular and neurologic complications of type 1 diabetes. We studied whether the use of intensive therapy as compared with conventional therapy during the Diabetes Control and Complications Trial (DCCT) affected the long-term incidence of cardiovascular disease.Methods: The DCCT randomly assigned 1441 patients with type 1 diabetes to intensive or conventional therapy, treating them for a mean of 6.5 years between 1983 and 1993. Ninety-three percent were subsequently followed until February 1, 2005, during the observational Epidemiology of Diabetes Interventions and Complications study. Cardiovascular disease (defined as nonfatal myocardial infarction, stroke, death from cardiovascular disease, confirmed angina, or the need for coronary-artery revascularization) was assessed with standardized measures and classified by an independent committee.Results: During the mean 17 years of follow-up, 46 cardiovascular disease events occurred in 31 patients who had received intensive treatment in the DCCT, as compared with 98 events in 52 patients who had received conventional treatment. Intensive treatment reduced the risk of any cardiovascular disease event by 42 percent (95 percent confidence interval, 9 to 63 percent; P=0.02) and the risk of nonfatal myocardial infarction, stroke, or death from cardiovascular disease by 57 percent (95 percent confidence interval, 12 to 79 percent; P=0.02). The decrease in glycosylated hemoglobin values during the DCCT was significantly associated with most of the positive effects of intensive treatment on the risk of cardiovascular disease. Microalbuminuria and albuminuria were associated with a significant increase in the risk of cardiovascular disease, but differences between treatment groups remained significant (P lessthan/equal 0.05) after adjusting for these factors.Conclusions: Intensive diabetes therapy has long-term beneficial effects on the risk of cardiovascular disease in patients with type 1 diabetes.