Effects of Severe Hypoglycemia on Cardiovascular Outcomes and Death in the Veterans Affairs Diabetes Trial
Effects of Severe Hypoglycemia on Cardiovascular Outcomes and Death in the Veterans Affairs Diabetes Trial
复制标题
DOI：
10.2337/dc18-1144
复制
发表时间：
2019-01-01
期刊：
影响因子：
16.2
通讯作者：
Reaven, Peter D., Jr.
中科院分区：
文献类型：
--
作者：
Davis, Stephen N.;Duckworth, William;Reaven, Peter D., Jr.
目的 确定退伍军人事务糖尿病试验 (VADT) 中严重低血糖的危险因素以及严重低血糖与严重心血管不良事件以及心血管和全因死亡率之间的关联。研究设计和方法这项对 VADT 数据的事后分析包括 1,791 名患有次优控制 2 型糖尿病的退伍军人（年龄 60.5 +/- 9.0 岁） (HbA(1c) 9.4 +/- 2.0%) 病程为 11.5 +/- 7.5 年，有或没有已知的心血管疾病和其他心血管危险因素。参与者被随机分为强化治疗组 (HbA(1c) < 7.0%) 与标准血糖控制组 (HbA(1c) < 8.5%)。 结果 强化治疗组的严重低血糖发生率为每 100 患者年 10.3 例，而标准治疗组为每 100 患者年 3.7 例 (P < 0.001)。在多变量分析中，基线时胰岛素使用（P = 0.02）、蛋白尿（P = 0.009）和自主神经病变（P = 0.01）是严重低血糖的独立危险因素，较高的BMI具有保护作用（P = 0.017）。过去 3 个月内严重低血糖与严重心血管事件 (P = 0.032)、心血管死亡率 (P = 0.012) 和总死亡率 (P = 0.024) 的风险增加相关。然而，与强化组相比，标准组的总死亡率风险增加相对较大（P = 0.019）。随着总体心血管风险的增加，严重低血糖与心血管事件之间的关联显着增加（P = 0.012）。 结论 无论血糖治疗组分配如何，过去 3 个月内的严重低血糖发作与主要心血管事件以及心血管和全因死亡率的风险增加相关。标准治疗进一步增加了严重低血糖后全因死亡的风险。
OBJECTIVETo determine the risk factors for severe hypoglycemia and the association between severe hypoglycemia and serious cardiovascular adverse events and cardiovascular and all-cause mortality in the Veterans Affairs Diabetes Trial (VADT).RESEARCH DESIGN AND METHODSThis post hoc analysis of data from the VADT included 1,791 military veterans (age 60.5 +/- 9.0 years) with suboptimally controlled type 2 diabetes (HbA(1c) 9.4 +/- 2.0%) of 11.5 +/- 7.5 years disease duration with or without known cardiovascular disease and additional cardiovascular risk factors. Participants were randomized to intensive (HbA(1c) < 7.0%) versus standard (HbA(1c) < 8.5%) glucose control.RESULTSThe rate of severe hypoglycemia in the intensive treatment group was 10.3 per 100 patient-years compared with 3.7 per 100 patient-years in the standard treatment group (P < 0.001). In multivariable analysis, insulin use at baseline (P = 0.02), proteinuria (P = 0.009), and autonomic neuropathy (P = 0.01) were independent risk factors for severe hypoglycemia, and higher BMI was protective (P = 0.017). Severe hypoglycemia within the past 3 months was associated with an increased risk of serious cardiovascular events (P = 0.032), cardiovascular mortality (P = 0.012), and total mortality (P = 0.024). However, there was a relatively greater increased risk for total mortality in the standard group compared with the intensive group (P = 0.019). The association between severe hypoglycemia and cardiovascular events increased significantly as overall cardiovascular risk increased (P = 0.012).CONCLUSIONSSevere hypoglycemic episodes within the previous 3 months were associated with increased risk for major cardiovascular events and cardiovascular and all-cause mortality regardless of glycemic treatment group assignment. Standard therapy further increased the risk for all-cause mortality after severe hypoglycemia.