目的评估我国40岁及以上糖尿病患者及其处于不同心血管疾病（CVD）发病风险时远期CVD发病率和缺血性、出血性心血管事件发生率。
方法本研究为前瞻性队列研究，研究对象来自中国动脉粥样硬化性心血管疾病风险预测研究（China-PAR），纳入全国15个省市40岁及以上人群，依据基线资料将调查对象分为糖尿病组和非糖尿病组；利用China-PAR模型计算研究对象10年CVD发病风险，以5%、10%为切点将研究对象分为低、中、高危。2007至2015年间对研究队列进行了2次随访，随访终点为CVD，包括非致死急性心肌梗死、冠心病死亡和卒中；按发病性质又进一步将终点事件分为缺血性和出血性心血管事件，其中缺血性事件包括非致死急性心肌梗死、冠心病死亡、非致死性和致死性缺血性卒中，出血性事件包括非致死性和致死性蛛网膜下腔出血和脑出血。比较糖尿病和非糖尿病人群及其在不同风险水平的CVD发病率及缺血性、出血性心血管事件发生率。
结果本研究共纳入40岁及以上人群89 209人，年龄（54.8±9.4）岁，其中男性36 794例（41.2%），平均随访时间8.5年。糖尿病组5 730例（6.4%）。≥40岁糖尿病患者中，10年CVD风险高危者占53.7%（3 075/5 730）。调整年龄、性别后，糖尿病患者CVD、缺血性和出血性心血管事件发生率（1 066.93/10万人年、824.23/10万人年和211.56/10万人年）低于CVD发病风险高危非糖尿病者（1 773.73/10万人年、1 228.18/10万人年和446.49/10万人年）（ P均<0.001）。在CVD高危人群中，与非糖尿病者相比，糖尿病患者缺血性心血管事件发病率更高（1 638.47/10万人年比1 228.18/10万人年， P<0.001），而出血性心血管事件发病率偏低，但差异无统计学意义（415.70/10万人年比446.49/10万人年， P=0.635）；在CVD低、中危人群中，两组的缺血性和出血性心血管事件发生率差异均无统计学意义（ P均>0.05）。
结论我国40岁及以上糖尿病患者中，半数以上处于CVD发病风险高危水平；不同CVD发病风险水平的糖尿病患者，CVD、缺血性和出血性心血管事件发生率差别明显。
ObjectiveTo evaluate the incidence of cardiovascular disease (CVD), ischemic and hemorrhagic cardiovascular events among Chinese diabetic patients aged 40 years and above with different CVD risk levels.
MethodsThis study enrolled participants aged 40 years and above in 15 provinces from a prospective cohort study, the China-PAR project (Prediction for Atherosclerotic Cardiovascular Disease Risk in China). Participants were categorized into two groups according to the presence or absence of diabetes at baseline. Individuals were further classified into low (0-4.9%), moderate (5%-9.9%) and high risk groups (≥10%), based on predicted ten-year CVD risk using the China-PAR equations. Two followed-up surveys were conducted between 2007 and 2015 to identify CVD events, which were defined as nonfatal acute myocardial infarction, or death due to coronary heart disease, or stroke. Ischemic cardiovascular events included nonfatal acute myocardial infarction, or death due to coronary heart disease, or ischemic stroke. Hemorrhagic cardiovascular events included subarachnoid hemorrhage and intracerebral hemorrhage. The incidences of CVD, ischemic and hemorrhagic cardiovascular events were compared in diabetes and non-diabetes population with different CVD risk levels.
ResultsThis study included 89 209 participants aged 40 years and above, the average follow-up period was 8.5 years. The age was (54.8±9.4) years, and 36 794 (41.2%) were men, and 5 730 (6.4%) were diabetic patients. In diabetes patients aged 40 years and above, 53.7% (3 075/5 730) were at high risk of CVD. Age-and sex-adjusted incidence of CVD, ischemic and hemorrhagic cardiovascular events (1 066.93/100 000 person-years, 824.23/100 000 person-years, and 211.56/100 000 person-years) were significantly lower in diabetes patients than those in non-diabetes population with high CVD risk (1 773.73/100 000 person-years, 1 228.18/100 000 person-years, and 446.49/100 000 person-years) (all P<0.001). Among high CVD risk populations, incidence of ischemic events was significantly higher in diabetic patients than in non-diabetes population (1 638.47/100 000 person-years vs. 1 228.18/100 000 person-years, P<0.001), but incidence of hemorrhagic events tended to be lower in diabetic patients than in non-diabetes population (415.70/100 000 person-years vs. 446.49/100 000 person-years, P=0.635). Incidence of ischemic and hemorrhagic events were similar between diabetes patients and non-diabetes population at low or moderate CVD risk groups (all P>0.05).
ConclusionsMore than half of diabetes patients aged 40 years and above in China have high CVD risk. The incidence of CVD, ischemic and hemorrhagic cardiovascular events are different in diabetic patients with different CVD risk levels.
李建新,李莹,刘芳超,等. 中国≥40岁糖尿病患者的心血管疾病风险[J]. 中华心血管病杂志,2020,48(11)：968-974.
DOI:10.3760/cma.j.cn112148-20191203-00733版权归中华医学会所有。
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李建新, 李莹, 刘芳超, 等. 中国≥40岁糖尿病患者的心血管疾病风险[J]. 中华心血管病杂志, 2020, 48(11): 968-974. DOI: 10.3760/cma.j.cn112148-20191203-00733.
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