Trends in cardiovascular complications of diabetes
Trends in cardiovascular complications of diabetes
复制标题
DOI：
10.1001/jama.292.20.2495
复制
发表时间：
2004-11-24
影响因子：
120.7
通讯作者：
Savage, PJ
中科院分区：
文献类型：
--
作者：
Fox, CS;Coady, S;Savage, PJ
背景尽管在过去的几十年里心血管疾病（CVD）死亡率有所下降，但目前尚不清楚是否有糖尿病和无糖尿病的成年人经历了类似的CVD风险下降。参与者年龄45-64岁，来自1950-1966年参加检查的心脏病研究原始和后代队列（“早期”时间段; 4118名参与者，113名糖尿病患者）和1977-1995年（“后期”时间段; 4063名参与者，317名糖尿病患者）。比较糖尿病患者和非糖尿病患者早期和晚期的心血管疾病发病率。主要指标心肌梗死、冠心病死亡和中风。结果在糖尿病患者中，年龄和性别调整后的心血管疾病发病率在早期为286.4/10000人年，在晚期为146.9/10000人年。下降49.3%（95%置信区间[Cl]，16.7%-69.4%）。在无糖尿病的参与者中，年龄和性别调整的发病率在早期为84.6/10000人年，在晚期为54.3/10000人年，下降了35.4%（95%CI，25.3%-45.4%）。风险比糖尿病作为一个预测事件的心血管疾病是没有不同的早期与晚期periods.Conclusions我们报告的发病率降低50%的成年糖尿病患者的心血管事件，虽然心血管疾病的绝对风险是2倍以上的人没有糖尿病。在过去的几十年里，患有糖尿病和没有糖尿病的成年人在CVD发病率下降的过程中受益匪浅。需要对CVD风险因素进行更积极的治疗，并进一步研究糖尿病特定因素对CVD的影响，以进一步降低糖尿病患者仍然经历的CVD的高绝对风险。
Context Despite reductions in cardiovascular disease (CVD) mortality over the past few decades, it is unclear whether adults with and without diabetes have experienced similar declines in CVD risk.Objective To determine whether adults with and without diabetes experienced similar declines in incident CVD in 1950-1995.Design, Setting, and Participants Participants aged 45-64 years from the Framingham Heart Study original and offspring cohorts who attended examinations in 1950-1966 ("earlier" time period; 4118 participants, 113 with diabetes) and 1977-1995 ("later" time period; 4063 participants, 317 with diabetes). Incidence rates of CVD among those with and without diabetes were compared between the earlier and later periods.Main Outcome Measures Myocardial infarction, coronary heart disease death, and stroke.Results Among participants with diabetes, the age- and sex-adjusted CVD incidence rate was 286.4 per 10000 person-years in the earlier period and 146.9 per 10000 in the later period, a 49.3% (95% confidence interval [Cl], 16.7%-69.4%) decline. Among participants without diabetes, the age- and sex-adjusted incidence rate was 84.6 per 10000 person-years in the earlier period and 54.3 per 10000 person-years in the later period, a 35.4% (95% Cl, 25.3%-45.4%) decline. Hazard ratios for diabetes as a predictor of incident CVD were not different in the earlier vs later periods.Conclusions We report a 50% reduction in the rate of incident CVD events among adults with diabetes, although the absolute risk of CVD is 2-fold greater than among persons without diabetes. Adults with and without diabetes have benefited similarly during the decline in CVD rates over the last several decades. More aggressive treatment of CVD risk factors and further research on diabetes-specific factors contributing to CVD, risk are needed to further reduce the high absolute risk of CVD still experienced by persons with diabetes.