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Cardiovasc Diabetol:1型糖尿病患者心肌梗死后的长期心血管预后

2022-09-10 MedSci原创 MedSci原创

与非糖尿病患者相比,1型糖尿病患者发生心肌梗死后的长期心血管预后明显更差

1 型糖尿病患者患心血管疾病 (CVD) 的风险翻了好几倍,他们发生首次CVD事件比一般人群早10-15年。心血管疾病是 1 型糖尿病患者死亡的主要原因,并导致这类高危人群过早死亡。

该研究旨在探讨 1 型糖尿病患者心肌梗死 (MI) 后的长期心血管预后。

通过多国家登记系统,回顾性地纳入了芬兰2005年-2018年期间心肌梗死后存活超过90天的1型糖尿病患者(n=1508, 60%的男性,平均62.1岁)和非糖尿病患者(n=62785)。主要终点是复合主要不良心血管事件(MACE;心血管死亡、复发性MI、缺血性卒中心衰住院)。通过多变量调整和倾向得分匹配来平衡组间的差异(倾向评分匹配的患者,各组1401位)。


有无糖尿病患者心肌梗死后的MACE事件累积发生率

中位随访了3.9年(最长12年)。与倾向评分匹配的非糖尿病患者相比,1型糖尿病患者心肌梗死后MACE的累积发生率较高(67.6% vs 46.0%;子分布风险比[sHR] 1.94,p<0.0001)。1型糖尿病患者发生心血管死亡(sHR 1.81,p<0.0001)、复发心肌梗死(sHRew 1.91,p<0.0001)、缺血性卒中(sHR 1.50,p=0.0003)和心衰住院(sHR 1.98,p<0.0001)的可能性均更高。


有无糖尿病患者心肌梗死后具体心血管事件的累积发生率

在性别(男性 vs 女性)、年龄(<60岁 vs ≥60岁)、血运重建和非血运重建患者的亚组分析中,糖尿病患者发生MACE事件的风险均高于非糖尿病患者,无论有无合并房颤、心衰和恶性肿瘤。

综上,与非糖尿病患者相比,1型糖尿病患者发生心肌梗死后的长期心血管预后明显更差。该研究结果强调了1型糖尿病患者心肌梗死后有效二级预防的重要性。

原始出处:

Kerola, A.M., Semb, A.G., Juonala, M. et al. Long-term cardiovascular prognosis of patients with type 1 diabetes after myocardial infarction. Cardiovasc Diabetol 21, 177 (2022). https://doi.org/10.1186/s12933-022-01608-3

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