Impact of diabetes and previous myocardial infarction on long-term survival - 25-year mortality follow-up of primary screenees of the multiple risk factor intervention trial
Impact of diabetes and previous myocardial infarction on long-term survival - 25-year mortality follow-up of primary screenees of the multiple risk factor intervention trial
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DOI：
10.1001/archinte.164.13.1438
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发表时间：
2004-07-12
影响因子：
--
通讯作者：
Stamler, J
中科院分区：
文献类型：
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作者：
Vaccaro, O;Eberly, LE;Stamler, J
背景：与糖尿病或既往心肌梗死(MI)相关的冠状动脉死亡风险的大小是有争议的。年龄、危险因素和随访持续时间的调节效应可能解释了先前研究中的差异。目的：比较有糖尿病或心肌梗死病史的男性的死亡率模式，并评估年龄、心血管危险因素和随访时间对死亡率的调节作用。方法：我们比较了4809例单纯糖尿病男性和4625例单纯心肌梗死男性(年龄在35-57岁之间)的25年死亡率。结果：仅有心肌梗死患者和仅有糖尿病患者的全因死亡率的调整风险比(HR)为0.97(95%可信区间，0.92-1.03；P=.32)。死亡模式不同：冠状动脉死亡率较高(HR=1.37；随访20年)，而非心血管死亡率的HR相对稳定。结论：总体而言，糖尿病和心肌梗死对总死亡率的预测作用相似。仅有糖尿病患者的非心血管原因死亡率较高，而在任何年龄和心血管危险因素水平上，既往心肌梗死对冠状动脉死亡率的预测都比糖尿病更强。两组冠脉死亡率的差异在随访的前10年最为明显。
Background: The magnitude of coronary mortality risk associated with diabetes or prior myocardial infarction (MI) is debatable. Modulating effects of age, risk factors, and duration of follow-up may explain discrepancies in previous research. Associations with noncardiovascular mortality are little explored.Objectives: To compare mortality patterns in men with a history of diabetes or MI and to assess modulating effects on mortality of age, cardiovascular risk factors, and follow-up duration.Methods: We compared the 25-year mortality of 4809 men with diabetes only and 4625 men with MI only (all men aged 35-57 years).Results: The adjusted hazard ratio (HR) for all-cause mortality for those with MI only vs those with diabetes only was 0.97 (95% confidence interval, 0.92-1.03; P = .32). The pattern of deaths was different: higher coronary mortality (HR = 1.37; P20 years of follow-up, respectively), whereas HRs for noncardiovascular mortality remained relatively constant.Conclusions: Overall, diabetes and MI were similarly strong predictors of total mortality. Higher mortality from noncardiovascular causes was observed in those with diabetes only, whereas prior MI was more strongly predictive of coronary mortality than diabetes at any age and level of cardiovascular risk factors. The difference in coronary mortality between the 2 groups was most evident in the first 10 years of follow-up.