Mortality and Cardiovascular Disease in Type 1 and Type 2 Diabetes
Mortality and Cardiovascular Disease in Type 1 and Type 2 Diabetes
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DOI：
10.1056/nejmoa1608664
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发表时间：
2017-04-13
影响因子：
158.5
通讯作者：
Gudbjornsdottir, Soffia
中科院分区：
文献类型：
--
作者：
Rawshani, Aidin;Rawshani, Araz;Gudbjornsdottir, Soffia
长期趋势的过度死亡和心血管疾病的后果还没有被广泛研究的人与1型糖尿病或2型diabetes. METHODS我们包括患者登记在瑞典国家糖尿病登记从1998年到2012年，并通过2014年。采用考克斯回归和标准化发病率估计死亡和心血管事件的趋势。对于每例患者，从一般人群中随机选择年龄、性别和县相匹配的对照组。在1型糖尿病患者中，研究期间每10，000人-年的哨点结局发生率的绝对变化如下：任何原因死亡，-31.4（95%置信区间[CI]，-56.1至-6.7）;心血管疾病死亡，-26.0（95% CI，-42.6至-9.4）;冠心病死亡，-21.7（95% CI，-37.1至-6.4）;因心血管疾病住院，-45.7（95% CI，-71.4至-20.1）。2型糖尿病患者每10，000人年的绝对变化如下：全因死亡，-69.6（95% CI，-95.9至-43.2）;心血管疾病死亡，-110.0（95% CI，-128.9至-91.1）;冠心病死亡，-91.9（95% CI，-108.9至-75.0）;因心血管疾病住院，-203.6（95% CI，-230.9至-176.3）。1型糖尿病患者的心血管结局比对照组降低约40%，2型糖尿病患者的心血管结局比对照组降低约20%。1型糖尿病患者和对照组的死亡结局减少相似，而2型糖尿病患者的死亡结局减少幅度小于对照组。结论在瑞典，从1998年到2014年，糖尿病患者的死亡率和心血管结局发生率大幅下降，尽管2型糖尿病患者的死亡结局下降幅度小于对照组。
BACKGROUNDLong-term trends in excess risk of death and cardiovascular outcomes have not been extensively studied in persons with type 1 diabetes or type 2 diabetes.METHODSWe included patients registered in the Swedish National Diabetes Register from 1998 through 2012 and followed them through 2014. Trends in deaths and cardiovascular events were estimated with Cox regression and standardized incidence rates. For each patient, controls who were matched for age, sex, and county were randomly selected from the general population.RESULTSAmong patients with type 1 diabetes, absolute changes during the study period in the incidence rates of sentinel outcomes per 10,000 person-years were as follows: death from any cause, -31.4 (95% confidence interval [CI], -56.1 to -6.7); death from cardiovascular disease, -26.0 (95% CI, -42.6 to -9.4); death from coronary heart disease, -21.7 (95% CI, -37.1 to -6.4); and hospitalization for cardiovascular disease, -45.7 (95% CI, -71.4 to -20.1). Absolute changes per 10,000 person-years among patients with type 2 diabetes were as follows: death from any cause, -69.6 (95% CI, -95.9 to -43.2); death from cardiovascular disease, -110.0 (95% CI, -128.9 to -91.1); death from coronary heart disease, -91.9 (95% CI, -108.9 to -75.0); and hospitalization for cardiovascular disease, -203.6 (95% CI, -230.9 to -176.3). Patients with type 1 diabetes had roughly 40% greater reduction in cardiovascular outcomes than controls, and patients with type 2 diabetes had roughly 20% greater reduction than controls. Reductions in fatal outcomes were similar in patients with type 1 diabetes and controls, whereas patients with type 2 diabetes had smaller reductions in fatal outcomes than controls.CONCLUSIONSIn Sweden from 1998 through 2014, mortality and the incidence of cardiovascular outcomes declined substantially among persons with diabetes, although fatal outcomes declined less among those with type 2 diabetes than among controls.