Is diabetes mellitus a cardiovascular disease risk equivalent for fatal stroke in women? Data from the Women's Pooling Project
Is diabetes mellitus a cardiovascular disease risk equivalent for fatal stroke in women? Data from the Women's Pooling Project
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DOI：
10.1161/01.str.0000102901.41780.5c
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发表时间：
2003-12-01
期刊：
影响因子：
8.3
通讯作者：
Mosca, L
中科院分区：
文献类型：
--
作者：
Ho, JE;Paultre, F;Mosca, L
背景和目的-糖尿病是卒中的独立危险因素，与非糖尿病受试者相比，其风险增加1.8至约6倍。最近的指南将糖尿病归类为冠心病风险等同物。糖尿病是否是中风的心血管疾病危险当量尚未建立。方法-数据来自美国9项前瞻性流行病学研究。我们跟踪了27269名妇女，（8.5%的糖尿病患者，2.9%的既往心肌梗死患者，2.3%的既往卒中患者）平均8.3年，结果：无心血管疾病的糖尿病患者和有既往卒中史的非糖尿病患者的卒中风险均显著增加10- 10%，与既往无心血管疾病的非糖尿病受试者相比，2010年卒中死亡率（风险比[ HR]，6.77; 95%置信区间[ CI]，4.56 - 10.05; HR，3.37; 95% CI，2.38 - 4.77）。既往心肌梗死史与长期卒中死亡率无关（HR，0.66; 95%CI，0.27 - 1.61）。校正危险因素后，糖尿病受试者与既往有卒中史的受试者相比有相似的风险（HR，1.29; P = 0.43）。结论-无心血管疾病的糖尿病受试者与既往有卒中史和相似危险因素的非糖尿病受试者有相似的致死性卒中风险。这表明糖尿病可被归类为卒中风险等同物，并可能在未来预防卒中时需要更积极的治疗策略。
Background and Purpose - Diabetes mellitus is an independent risk factor for stroke and is associated with a 1.8- to approximate to 6- fold increased risk compared with nondiabetic subjects. Recent guidelines have classified diabetes as a coronary heart disease risk equivalent. Whether diabetes is a cardiovascular disease risk equivalent for stroke is not established.Methods - Data were pooled from 9 prospective epidemiological studies in the United States. We followed up 27 269 women ( 8.5% diabetic, 2.9% with prior myocardial infarction, 2.3% with prior stroke) for an average of 8.3 years, during which 238 stroke deaths were observed.Results - Both diabetic subjects without cardiovascular disease and nondiabetic subjects with history of prior stroke had a significantly increased risk of 10- year stroke mortality compared with nondiabetic subjects without prior cardiovascular disease ( hazard ratio [ HR], 6.77; 95% confidence interval [ CI], 4.56 to 10.05; HR, 3.37; 95% CI, 2.38 to 4.77). History of prior myocardial infarction was not associated with long- term stroke mortality ( HR, 0.66; 95% CI, 0.27 to 1.61). After adjustment for risk factors, diabetic subjects had similar risk compared with subjects with a history of prior stroke ( HR, 1.29; P = 0.43).Conclusions - Diabetic subjects without cardiovascular disease have a fatal stroke risk similar to that of nondiabetic subjects with a history of prior stroke and similar risk factor profile. This suggests that diabetes mellitus may be classified as a stroke risk equivalent and may warrant more aggressive treatment strategies in the future prevention of stroke.