| アブストラクト | BACKGROUND: To examine the association between the degree of risk factor control and cardiovascular disease (CVD) risk in type 2 diabetes and to assess if the presence of cardio-renal disease modifies these relationships. METHODS: A retrospective cohort study using data from English practices from CPRD GOLD (Clinical Practice Research Datalink) and the SCI-Diabetes dataset (Scottish Care Information-Diabetes), with linkage to hospital and mortality data. We identified 101 749 with type 2 diabetes (T2D) in CPRD matched with 378 938 controls without diabetes and 330 892 with type 2 diabetes in SCI-Diabetes between 2006 and 2015. The main exposure was number of optimized risk factors: nonsmoker, total cholesterol </=4 mmol/L, triglycerides </=1.7 mmol/L, glycated haemoglobin (HbA1c) </=53 mmol/mol (</=7.0%), systolic blood pressure <140mm Hg, or <130 mm Hg if high risk. Cox models were used to assess cardiovascular risk associated with levels of risk factor control. RESULTS: In CPRD, the mean baseline age in T2D was 63 years and 28% had cardio-renal disease (SCI-Diabetes: 62 years; 35% cardio-renal disease). Over 3 years follow-up (SCI-Diabetes: 6 years), CVD events occurred among 27 900 (27%) CPRD-T2D, 101 362 (31%) SCI-Diabetes-T2D, and 75 520 (19%) CPRD-controls. In CPRD, compared with controls, T2D participants with optimal risk factor control (all risk factors controlled) had a higher risk of CVD events (adjusted hazard ratio, 1.21; 95% confidence interval, 1.12-1.29). In T2D participants from CPRD and SCI-Diabetes, pooled hazard ratios for CVD associated with 5 risk factors being elevated versus optimal risk factor control were 1.09 (95% confidence interval, 1.01-1.17) in people with cardio-renal disease but 1.96 (95% confidence interval, 1.82-2.12) in people without cardio-renal disease. People without cardio-renal disease were younger and more likely to have likely to have suboptimal risk factor control but had fewer prescriptions for risk factor modifying medications than those with cardio-renal disease. CONCLUSIONS: Optimally managed people with T2D have a 21% higher CVD risk when compared with controls. People with T2D without cardio-renal disease would be predicted to benefit greatly from CVD risk factor intervention. |
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| 投稿者 | Wright, Alison K; Suarez-Ortegon, Milton Fabian; Read, Stephanie H; Kontopantelis, Evangelos; Buchan, Iain; Emsley, Richard; Sattar, Naveed; Ashcroft, Darren M; Wild, Sarah H; Rutter, Martin K |
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| 組織名 | Division of Diabetes, Endocrinology and Gastroenterology, School of Medical;Sciences, University of Manchester, United Kingdom (A.K.W., M.K.R.).;Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and;Optometry, School of Health Sciences, University of Manchester, United Kingdom;(A.K.W., D.M.A.).;Departamento de Alimentacion y Nutricion, Facultad de Ciencias de la Salud,;Pontificia Universidad Javeriana Seccional Cali, Colombia (M.F.S.-O.).;Grupo de Investigacion en Ciencias Basicas y Clinicas de la Salud, Facultad de;Ciencias de la Salud, Pontificia Universidad Javeriana Seccional Cali, Colombia;(M.F.S.-O.).;Usher Institute of Population Health Sciences and Informatics, University of;Edinburgh, United Kingdom (S.H.R., S.H.W.).;Women's College Research Institute, Women's College Hospital, Toronto, Ontario,;Canada (S.H.R.).;Scottish Diabetes Research Network epidemiology group, Scotland, United Kingdom;(S.H.W.).;Division of Informatics, Imaging and Data Sciences, School of Health Sciences,;University of Manchester, United Kingdom (E.K.).;Department of Public Health and Policy, Institute of Population Health Sciences,;University of Liverpool, United Kingdom (I.B.).;Health eResearch Center, Farr Institute, Division of Informatics, Imaging & Data;Sciences, School of Health Sciences, University of Manchester, United Kingdom;(I.B.).;Department of Biostatistics & Health Informatics, Institute of Psychiatry,;Psychology and Neuroscience, King's College London, United Kingdom (R.E.).;Institute of Cardiovascular & Medical Sciences, University of Glasgow, United;Kingdom (N.S.).;Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS;Foundation Trust, Manchester Academic Health Sciences Centre, United Kingdom;(M.K.R.). |
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