Type 2 diabetes and incidence of cardiovascular diseases: a cohort study in 1·9 million people.
Type 2 diabetes and incidence of cardiovascular diseases: a cohort study in 1·9 million people.
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DOI：
10.1016/s0140-6736(15)60401-9
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发表时间：
2015-02-01
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影响因子：
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通讯作者：
Hemingway, Harry
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作者：
Shah, Anoop Dinesh;Langenberg, Claudia;Hemingway, Harry
背景：目前2型糖尿病与多种心血管疾病的相关性尚未进行比较。以前的研究集中在心肌梗死和中风，这些情况是2型糖尿病临床试验中选择的常见结果，但其他疾病如心力衰竭和心绞痛也是糖尿病发病的主要原因。我们的目的是研究2型糖尿病和心血管疾病的12个初始表现之间的关联。方法：我们使用1997年至2010年的电子健康记录在CALIBER（使用链接定制研究和电子健康记录的心血管研究）计划中，调查英格兰192万例患者队列中与2型糖尿病相关的绝对和相对风险。我们纳入了30岁及以上基线时无心血管疾病的患者。该研究在ClinicalTrials.gov注册，编号NCT 01804439。结果：在中位随访5·5年（IQR 2·1-10·1）期间，我们观察到113 638例首次出现心血管疾病。 34198人患有2型糖尿病：6137人首次出现心血管症状，其中最常见的是外周动脉疾病（16.2%，n=992）和心力衰竭（14.1%，n=866）。 2型糖尿病与外周动脉疾病密切相关（校正的原因特异性风险比2·98，95% CI 2·76-3·22），缺血性卒中（1·72，1·52-1·95），稳定型心绞痛（1·62，1·49-1·77），心力衰竭（1·56，1·45-1·69）和非致死性心肌梗死（1.54 ± 1.42 ~ 1.67），但与腹主动脉瘤呈负相关（0·46，0·35-0·59）和蛛网膜下腔出血（0.48，0.26 - 0.89）.解释：这项研究表明2型糖尿病与不同的心血管疾病的关系是不同的。这些发现对临床风险评估和2型糖尿病试验主要终点的选择具有重要意义。基金来源：英国医学研究理事会国家健康研究所Wellcome Trust。背景：目前2型糖尿病与各种心血管疾病的关联尚未进行比较。我们的目的是研究2型糖尿病和心血管疾病的12个初始表现之间的关联。方法：我们使用了相关的初级保健，住院，疾病登记和死亡证明记录从CALIBER程序，链接数据记录在英格兰的人在四个电子健康数据源。我们纳入了1998年1月1日至2010年3月25日期间30岁或30岁以上的人，他们在基线时没有心血管疾病。主要终点是任何数据源中12种心血管表现之一的首次记录。我们比较了心血管疾病初始表现的累积发病率曲线，并使用考克斯模型估计病因特异性风险比（HR）。ClinicalTrials.gov研究结果：我们的队列由1 921 260人组成，其中1 887 062人（98.2%）没有糖尿病，34 198人（1.8%）患有2型糖尿病。 在中位随访5.5年（IQR 2.1 - 10.1）期间，我们观察到113638例首次出现心血管疾病。在2型糖尿病患者中，6137例（17.9%）首次出现心血管症状，其中最常见的是外周动脉疾病（6137例患者中有992例[16.2%]报告）和心力衰竭（6137例患者中有866例[14.1%]）。2型糖尿病与外周动脉疾病呈正相关（校正HR 2.98 [95% CI 2.76 - 3.22]），缺血性卒中（1·72 [1·52-1·95]），稳定型心绞痛（1·62 [1·49-1·77]），心力衰竭（1·56 [1·45-1·69]）和非致死性心肌梗死（1·54 [1·42-1·67]），但与腹主动脉瘤呈负相关（0·46 [0·35-0·59]）和蛛网膜下腔出血（0·48 [0·26- 0·89]），与心律失常或心源性猝死无关（0·95 [0·76-1·19]）。解释：心力衰竭和外周动脉疾病是2型糖尿病心血管疾病最常见的初始表现。2型糖尿病患者不同心血管疾病相对风险的差异对临床风险评估和试验设计具有重要意义。资金来源：Wellcome Trust，National Institute for Health Research，and Medical Research理事会。
BACKGROUND: The contemporary associations of type 2 diabetes with a wide range of incident cardiovascular diseases have not been compared. Previous studies have focussed on myocardial infarction and stroke, and these conditions are the usual outcomes chosen in clinical trials in type 2 diabetes, but other diseases such as heart failure and angina are also major causes of morbidity in diabetes. We aimed to study associations between type 2 diabetes and 12 initial manifestations of cardiovascular disease.METHODS: We used linked electronic health records from 1997 to 2010 in the CALIBER (cardiovascular research using linked bespoke studies and electronic health records) programme to investigate the absolute and relative risks associated with type 2 diabetes in a cohort of 1·92 million patients in England. We included patients aged 30 years and older who were free from cardiovascular disease at baseline. This study is registered with ClinicalTrials.gov, number NCT01804439.FINDINGS: We observed 113 638 first presentations of cardiovascular disease during a median follow-up of 5·5 years (IQR 2·1-10·1). 34 198 people had type 2 diabetes: 6137 experienced a first cardiovascular presentation, of which the most common were peripheral arterial disease (16·2%, n=992) and heart failure (14·1%, n=866). Type 2 diabetes was strongly positively associated with peripheral arterial disease (adjusted cause-specific hazard ratio 2·98, 95% CI 2·76-3·22), ischaemic stroke (1·72, 1·52-1·95), stable angina (1·62, 1·49-1·77), heart failure (1·56, 1·45-1·69), and non-fatal myocardial infarction (1·54 1·42-1·67), but inversely associated with abdominal aortic aneurysm (0·46, 0·35-0·59) and subarachnoid haemorrhage (0·48, 0·26-0·89).INTERPRETATION: This study suggests that associations of type 2 diabetes vary with different incident cardiovascular diseases. These findings have implications for clinical risk assessment and choice of primary endpoint in trials on type 2 diabetes.FUNDING: Wellcome Trust, National Institute for Health Research, UK Medical Research Council.BACKGROUND: The contemporary associations of type 2 diabetes with a wide range of incident cardiovascular diseases have not been compared. We aimed to study associations between type 2 diabetes and 12 initial manifestations of cardiovascular disease.METHODS: We used linked primary care, hospital admission, disease registry, and death certificate records from the CALIBER programme, which links data for people in England recorded in four electronic health data sources. We included people who were (or turned) 30 years or older between Jan 1, 1998, to March 25, 2010, who were free from cardiovascular disease at baseline. The primary endpoint was the first record of one of 12 cardiovascular presentations in any of the data sources. We compared cumulative incidence curves for the initial presentation of cardiovascular disease and used Cox models to estimate cause-specific hazard ratios (HRs). This study is registered at ClinicalTrials.gov (NCT01804439).FINDINGS: Our cohort consisted of 1 921 260 individuals, of whom 1 887 062 (98·2%) did not have diabetes and 34 198 (1·8%) had type 2 diabetes. We observed 113 638 first presentations of cardiovascular disease during a median follow-up of 5·5 years (IQR 2·1-10·1). Of people with type 2 diabetes, 6137 (17·9%) had a first cardiovascular presentation, the most common of which were peripheral arterial disease (reported in 992 [16·2%] of 6137 patients) and heart failure (866 [14·1%] of 6137 patients). Type 2 diabetes was positively associated with peripheral arterial disease (adjusted HR 2·98 [95% CI 2·76-3·22]), ischaemic stroke (1·72 [1·52-1·95]), stable angina (1·62 [1·49-1·77]), heart failure (1·56 [1·45-1·69]), and non-fatal myocardial infarction (1·54 [1·42-1·67]), but was inversely associated with abdominal aortic aneurysm (0·46 [0·35-0·59]) and subarachnoid haemorrhage (0·48 [0·26-0.89]), and not associated with arrhythmia or sudden cardiac death (0·95 [0·76-1·19]).INTERPRETATION: Heart failure and peripheral arterial disease are the most common initial manifestations of cardiovascular disease in type 2 diabetes. The differences between relative risks of different cardiovascular diseases in patients with type 2 diabetes have implications for clinical risk assessment and trial design.FUNDING: Wellcome Trust, National Institute for Health Research, and Medical Research Council.