Incidence and risk factors for stroke in type 2 diabetic patients - The DAI study
Incidence and risk factors for stroke in type 2 diabetic patients - The DAI study
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DOI：
10.1161/01.str.0000260100.71665.2f
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发表时间：
2007-04-01
期刊：
影响因子：
8.3
通讯作者：
Ferrannini, Ele
中科院分区：
文献类型：
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作者：
Giorda, Carlo Bruno;Avogaro, Angelo;Ferrannini, Ele
背景与目的：2型糖尿病是脑血管疾病的重要预测因子，但很少有研究评估未选择的2型糖尿病人群中卒中的发生率和其他危险因素的作用。方法：前瞻性随访14 432例2型糖尿病患者，年龄40 ~ 97岁，入组时有无心血管病史，估计卒中发生率及相关临床变量的危险比。结果：在4年的随访中，记录了296例卒中事件。在没有心血管疾病史的人群中，男性的年龄标准化卒中发病率（每1000人年）为5.5(95%可信区间，4.2至6.8)，女性为6.3（95%可信区间，4.5至8.2）。在有心血管疾病史的人群中，男性为13.7(95%可信区间，7.5 - 19.8)，女性为10.8（95%可信区间，7.3 - 14.4）。卒中发病率的危险比因年龄、性别和心血管病史而异。在没有病史的男性中，糖化血红蛋白和吸烟是中风的预测因素。在有病史的患者中，危险因素是，在男性中，胰岛素加口服药物治疗，治疗高总胆固醇和低高密度脂蛋白胆固醇，而在女性微血管并发症是一个危险因素。无论男女，先前的中风都是中风的一个强有力的预测因素。结论：年龄和既往脑卒中是糖尿病患者脑卒中的主要预测因素。Hba1c、微血管并发症、低HDL胆固醇以及胰岛素加口服药物治疗的综合作用突出了糖尿病病史和临床背景在卒中发生中的重要性。
Background and Purpose-Type 2 diabetes mellitus is a strong predictor of cerebrovascular disease, yet few studies have assessed the incidence of stroke and the role of other risk factors in unselected type 2 diabetes mellitus populations.Methods-We prospectively followed-up 14 432 type 2 diabetes mellitus patients, aged 40 to 97 years, with and without a history of cardiovascular disease at enrollment, and we estimated the incidence of stroke and the hazards ratios with respect to clinical variables.Results-During a 4-year follow-up, 296 incident stroke events were recorded. In persons with no history of cardiovascular disease, the age-standardized incidence of stroke (per 1000 person-years) was 5.5 (95% confidence interval, 4.2 to 6.8) in men and 6.3 (95% confidence interval, 4.5 to 8.2) in women. In persons with a history of cardiovascular disease, it was 13.7 (95% confidence interval, 7.5 to 19.8) in men and 10.8 (95% confidence interval, 7.3 to 14.4) in women. The hazards ratios of stroke incidence varied according to age, sex, and history of cardiovascular disease. Among men with no history, HbA1c and smoking were predictors of stroke. Among patients with a history, the risk factors were, in men, therapy with insulin plus oral agents, treated high total cholesterol and low HDL cholesterol, whereas in women microvascular complications were a risk factor. Previous stroke was a strong predictor of stroke in both sexes.Conclusions-Age and previous stroke are the main predictors of stroke in diabetes. The combined role of Hba1c, microvascular complications, low HDL cholesterol, and treatment with insulin plus oral agents highlights the importance of diabetic history and clinical background in the development of stroke.