The Association of Severe Hypoglycemia With Incident Cardiovascular Events and Mortality in Adults With Type 2 Diabetes.
The Association of Severe Hypoglycemia With Incident Cardiovascular Events and Mortality in Adults With Type 2 Diabetes.
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DOI：
10.2337/dc17-1669
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发表时间：
2018-01
期刊：
影响因子：
16.2
通讯作者：
Selvin E
中科院分区：
文献类型：
--
作者：
Lee AK;Warren B;Lee CJ;McEvoy JW;Matsushita K;Huang ES;Sharrett AR;Coresh J;Selvin E
有提示性证据表明低血糖与心血管疾病有关，但在社区环境中收集的数据很少。缺乏关于个体心血管结局和病因特异性死亡率的信息。我们对来自社区动脉粥样硬化风险（ARIC）研究（分析基线，1996-1998）的1，209名诊断为糖尿病的参与者进行了前瞻性队列分析。使用第一位ICD-9代码从2013年的住院、急诊和救护车呼叫中识别重度低血糖发作。收集了2013年的心血管事件和死亡。我们使用调整后的考克斯回归模型，低血糖作为随时间变化的暴露。在中位随访15.3年期间，有195名参与者至少有一次严重的低血糖发作。严重低血糖后3年累计冠心病发生率为10.8%，死亡率为28.3%。调整后，严重低血糖与冠心病相关（风险比[HR] 2.02，95% CI 1.27-3.20），全因死亡（HR 1.73，95% CI 1.38-2.17）、心血管死亡率（HR 1.64，95% CI 1.15-2.34）和癌症死亡率（HR 2.49，95% CI 1.46-4.24）。低血糖与中风、心力衰竭、房颤或非心血管和非癌症死亡无关。在按年龄、性别、种族、糖尿病病程和基线心血管风险定义的亚组中，结果是稳健的。严重低血糖明确表明健康状况下降，是心血管事件和死亡率绝对风险高的有力标志。
There is suggestive evidence linking hypoglycemia with cardiovascular disease, but few data have been collected in a community-based setting. Information is lacking on individual cardiovascular outcomes and cause-specific mortality. We conducted a prospective cohort analysis of 1,209 participants with diagnosed diabetes from the Atherosclerosis Risk in Communities (ARIC) study (analytic baseline, 1996–1998). Severe hypoglycemic episodes were identified using first position ICD-9 codes from hospitalizations, emergency department visits, and ambulance calls through 2013. Cardiovascular events and deaths were captured through 2013. We used adjusted Cox regression models with hypoglycemia as a time-varying exposure. There were 195 participants with at least one severe hypoglycemic episode during a median fellow-up of 15.3 years. After severe hypoglycemia, the 3-year cumulative incidence of coronary heart disease was 10.8% and of mortality was 28.3%. After adjustment, severe hypoglycemia was associated with coronary heart disease (hazard ratio [HR] 2.02, 95% CI 1.27–3.20), all-cause mortality (HR 1.73, 95% CI 1.38–2.17), cardiovascular mortality (HR 1.64, 95% CI 1.15–2.34), and cancer mortality (HR 2.49, 95% CI 1.46–4.24). Hypoglycemia was not associated with stroke, heart failure, atrial fibrillation, or noncardiovascular and noncancer death. Results were robust within subgroups defined by age, sex, race, diabetes duration, and baseline cardiovascular risk. Severe hypoglycemia is clearly indicative of declining health and is a potent marker of high absolute risk of cardiovascular events and mortality.
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影响因子：
16.2
作者：
Frier BM;Schernthaner G;Heller SR
通讯作者：
Heller SR
影响因子：
6.3
作者：
Cruz-Jentoft, Alfonso J.;Carpena-Ruiz, Marina;Sanchez-Garcia, Elisabet
通讯作者：
Sanchez-Garcia, Elisabet
影响因子：
158.5
作者：
Duckworth, William;Abraira, Carlos;Huang, Grant D.
通讯作者：
Huang, Grant D.
影响因子：
39.3
作者：
Mellbin, Linda G.;Ryden, Lars;Gerstein, Hertzel C.
通讯作者：
Gerstein, Hertzel C.
影响因子：
158.5
作者：
Gerstein, Hertzel C.;Miller, Michael E.;Friedewald, William T.
通讯作者：
Friedewald, William T.