Cardiovascular outcomes in framingham participants with diabetes: the importance of blood pressure.
Cardiovascular outcomes in framingham participants with diabetes: the importance of blood pressure.
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DOI：
10.1161/hypertensionaha.110.162446
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发表时间：
2011-05
期刊：
影响因子：
--
通讯作者：
Campbell NR
中科院分区：
文献类型：
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作者：
Chen G;McAlister FA;Walker RL;Hemmelgarn BR;Campbell NR
我们设计了这项研究，以探讨在何种程度上的糖尿病患者的心血管事件的过度风险归因于高血压。我们回顾性分析了前瞻性收集的来自Fracket原始和后代队列的数据。在1145名新诊断为糖尿病的无心血管事件既往史的Fragrance受试者中，663名（58%）在诊断糖尿病时患有高血压。在4154人年的随访中，125人死亡，204人发生心血管事件。与血压正常的糖尿病受试者相比，在糖尿病诊断时患有高血压的受试者显示出更高的全因死亡率（32对20/1000人年，p<0.001）和心血管事件（52对31/1000人年，p<0.001）。在调整人口统计学和临床协变量后，高血压与糖尿病患者全因死亡风险增加72%和任何心血管事件风险增加57%相关。糖尿病患者高血压的人群归因风险为全因死亡30%，任何心血管事件25%（如果将随访期间发生高血压的110名血压正常受试者从分析中排除，则分别增加至44%和41%）。相比之下，在校正并发高血压后，Frachial受试者中糖尿病的人群归因风险为7%的全因死亡率和9%的任何CVD事件。虽然糖尿病与空腹受试者死亡和心血管事件风险增加相关，但这种过度风险大部分可归因于共存的高血压。
We designed this study to explore to what extent the excess risk of cardiovascular events in diabetic individuals is attributable to hypertension. We retrospectively analyzed prospectively collected data from the Framingham Original and Offspring cohorts. Of the 1145 Framingham subjects newly diagnosed with diabetes who did not have a prior history of cardiovascular events, 663 (58%) had hypertension at the time diabetes was diagnosed. During 4154 person-years of follow-up, 125 died and 204 suffered a cardiovascular event. Framingham participants with hypertension at the time of diabetes diagnosis exhibited higher rates of all cause mortality (32 versus 20 per 1000 person years, p<0.001) and cardiovascular events (52 versus 31 per 1000 person years, p<0.001) compared with normotensive subjects with diabetes. After adjustment for demographic and clinical covariates, hypertension was associated with a 72% increase in the risk of all cause death and a 57% increase in the risk of any cardiovascular event in individuals with diabetes. The population attributable risk from hypertension in individuals with diabetes was 30% for all-cause death and 25% for any cardiovascular event (increasing to 44% and 41% respectively if the 110 normotensive subjects who developed hypertension during follow-up were excluded from the analysis). In comparison, after adjustment for concurrent hypertension, the population attributable risk from diabetes in Framingham subjects was 7% for all cause mortality and 9% for any CVD event. While diabetes is associated with increased risks of death and cardiovascular events in Framingham subjects, much of this excess risk is attributable to coexistent hypertension.