成人糖尿病患者的冠心病死亡率出现长期降低：队列研究

Secular decline in mortality from coronary heart disease in adults with diabetes mellitus： cohort study

目的 探讨糖尿病与非糖尿病成人致死性冠心病的患病趋势。 设计 队列研究。 地点 Nord-Trondelag健康研究（HUNT）的两次调查，以挪威人群为基础的研究。 参试者 参加第一次（1984—1986）和第二次（1995—1997）调查的人员分别有74914和64829名，包括男性和女性。 主要结局评估指标 9年连续随访期间，两次糖尿病与非糖尿病成人的年龄关联冠心病死亡率。 结果 共计2623名男性和1583名女性死于冠心病。最近随访期中的死亡率显著降低：70～79岁非糖尿病组中，每1000人年死亡男性从16．38下降到8．79（减少48％，95％可信区间为39％～55％），女性从6．84下降到2．68（减少62％，52％～70％）。而同年龄组糖尿病患者中，每1000人年死亡男性从38．97下降到17．89（减少54％，32％～69％），女性从28．15下降到11．83（减少59％，37％～73％）。在基线年龄小于70岁组中减少更为显著，而在80岁及以上组中减少则较小。糖尿病患者其冠心病死亡率比非糖尿病者高2倍多，女性更为显著。在两次调查中，糖尿病状态导致的死亡率基本无差异。 结论 从第一次到第二次调查中，冠心病死亡率的普遍明显降低对糖尿病患者有益；但糖尿病相关的冠心病死亡率较一般人群高2倍多这一事实并没有随着时间的推移而改变。

Objective To examine trends in fatal coronary heart disease in adults with and without diabetes. Design Cohort study. Setting Two surveys of the Nord-Tnandelag health study （HUNT）, a population based study in Norway. Participants 74 914 men and women from the first survey （ 1984-6 ） and 64 829 from the second survey （1995-7）. Main outcome measure Age specific mortality from coronary heart disease among adults with and without diabetes during two consecutive nine year follow-up periods. Results A total of 2623 men and 1583 women died from eoronary heart disease. Mortality rates were substantially lower during the most recent follow-up period： among men aged 70 -79 without diabetes, deaths per 1000 person years declined from 16. 38 to 8. 79 （reduction 48%, 95% confidence interval 39% to 55% ） and among women aged 70 - 79 from 6.84 to 2. 68 （62%, 52% to 70% ）. Among the same age group with diabetes, deaths per 1000 person years in men declined from 38. 97 to 17.89 （54%, 32% to 69% ） and in women from 28.15 to 11.83 （59%, 37% to 73% ）. The reduction was more noticeable in age groups younger than 70 at baseline, and less pronounced among people aged 80 or more. Mortality from coronary heart disease was mere than twofold higher in people with than without diabetes, with a slightly stronger association in women. The difference in mortality by diabetes status remained almost unchanged from the first to the second survey. Conclusion The strong general reduetion in mortality rates from coronary heart disease from the first to the second follow-up period also benefited people with diabetes, but the more than twofold higher mortality from coronary heart disease associated with diabetes persisted over time.