DIABETES, OTHER RISK-FACTORS, AND 12-YR CARDIOVASCULAR MORTALITY FOR MEN SCREENED IN THE MULTIPLE RISK FACTOR INTERVENTION TRIAL
DIABETES, OTHER RISK-FACTORS, AND 12-YR CARDIOVASCULAR MORTALITY FOR MEN SCREENED IN THE MULTIPLE RISK FACTOR INTERVENTION TRIAL
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DOI：
10.2337/diacare.16.2.434
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发表时间：
1993-02-01
期刊：
影响因子：
16.2
通讯作者：
WENTWORTH, D
中科院分区：
文献类型：
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作者：
STAMLER, J;VACCARO, O;WENTWORTH, D
目的 - 评估患有和不患有糖尿病的男性 CVD 死亡率的预测因素，并评估糖尿病对 CVD 死亡风险的独立影响。 研究设计和方法 - 该队列研究的参与者于 1973 年至 1975 年进行筛选；平均12年的随访（范围11-13年）已确定生命状况。参与者为 347,978 名 35-57 岁的男性，在 20 个 MRFIT 中心进行了筛查。结果衡量标准是 CVD 死亡率。 结果 - 在 5163 名报告服用糖尿病药物的男性中，平均 12 年的随访期间发生了 1092 例死亡（603 例 CVD 死亡）。在 342,815 名未服用糖尿病药物的男性中，有 20,867 人死亡，其中 8965 人死于心血管疾病。在对年龄、种族、收入、血清胆固醇水平、收缩压和报告的每天吸烟数量进行调整后，糖尿病患者的 CVD 死亡绝对风险比各个年龄层、种族背景和危险因素水平的非糖尿病男性高得多，总体高出三倍（P < 0.000 1）。对于患有和不患有糖尿病的男性来说，血清胆固醇水平、收缩压和吸烟是心血管疾病死亡率的重要预测因素。对于每个危险因素及其组合的值较高的糖尿病男性，CVD 死亡的绝对风险比非糖尿病男性急剧增加，因此，糖尿病男性的绝对超额风险逐渐大于具有较高危险因素水平的非糖尿病男性。 结论 - 这些发现强调了对糖尿病患者进行严格持续干预以控制血压、降低血清胆固醇和戒烟的重要性，以及 大规模考虑营养卫生方法来预防糖尿病的重要性。
OBJECTIVE - To assess predictors of CVD mortality among men with and without diabetes and to assess the independent effect of diabetes on the risk of CVD death.RESEARCH DESIGN AND METHODS - Participants in this cohort study were screened from 1973 to 1975; vital status has been ascertained over an average of 12 yr of follow-up (range 11-13 yr). Participants were 347,978 men aged 35-57 yr, screened in 20 centers for MRFIT. The outcome measure was CVD mortality.RESULTS - Among 5163 men who reported taking medication for diabetes, 1092 deaths (603 CVD deaths) occurred in an average of 12 yr of follow-up. Among 342,815 men not taking medication for diabetes, 20,867 deaths were identified, 8965 ascribed to CVD. Absolute risk of CVD death was much higher for diabetic than nondiabetic men of every age stratum, ethnic background, and risk factor level-overall three times higher, with adjustment for age, race, income, serum cholesterol level, sBP, and reported number of cigarettes/day (P < 0.000 1). For men both with and without diabetes, serum cholesterol level, sBP, and cigarette smoking were significant predictors of CVD mortality. For diabetic men with higher values for each risk factor and their combinations, absolute risk of CVD death increased more steeply than for nondiabetic men, so that absolute excess risk for diabetic men was progressively greater than for nondiabetic men with higher risk factor levels.CONCLUSIONS - These findings emphasize the importance of rigorous sustained intervention in people with diabetes to control blood pressure, lower serum cholesterol, and abolish cigarette smoking, and the importance of considering nutritional-hygienic approaches on a mass scale to prevent diabetes.