期刊
LANCET DIABETES & ENDOCRINOLOGY
卷 3, 期 2, 页码 105-113出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/S2213-8587(14)70219-0
关键词
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资金
- National Institute for Health Research [RP-PG-0407-10314, NIHR/CS/009/004]
- Wellcome Trust [WT 086091/Z/08/Z, 098504, 0938/30/Z/10/Z]
- Medical Research Prognosis Research Strategy Partnership [G0902393/99558]
- Farr Institute of Health Informatics Research - Medical Research Council [K006584/1]
- Arthritis Research UK
- British Heart Foundation
- Cancer Research UK
- Economic and Social Research Council
- Engineering and Physical Sciences Research Council
- National Institute of Health Research
- National Institute for Social Care and Health Research (Welsh Assembly Government)
- Chief Scientist Office (Scottish Government Health Directorates)
- University College London Provost's Strategic Development Fund fellowship
- Barts and the London Cardiovascular Biomedical Research Unit - National Institute for Health Research
- ESRC [ES/L007517/1] Funding Source: UKRI
- MRC [G0902393, MR/L01629X/1, MC_UU_12015/1] Funding Source: UKRI
- Economic and Social Research Council [ES/L007517/1] Funding Source: researchfish
- Medical Research Council [G0902393, MC_U106179471, MC_UU_12015/1, MR/K006584/1, MR/L01629X/1] Funding Source: researchfish
- National Institute for Health Research [NF-SI-0510-10090, RP-PG-0407-10314, NIHR/CS/009/004] Funding Source: researchfish
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 fi rst 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. Copyright (C) Shah et al. Open Access article distributed under the terms of CC BY.
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