摘要
背景:糖尿病是美国的一个主要的公共健康问题。作者评估了达拉斯县糖尿病的患病率,定量分析糖尿病与亚临床心血管疾病之间的关系,此外还评价循证心血管疾病危险因素干预治疗的应用。方法:本研究所采用数据来自达拉斯心脏研究中3392例年龄30～65岁的参与者。达拉斯心脏研究是在德克萨斯州达拉斯县居民中进行的一项基于概率的多民族抽样调查。
Background: Diabetes mellitus is a major public health problem in the United States. We assess the prevalence of diabetes in Dallas County, quantify the association between diabetes and subclinical cardiovascular disease, and assess the use of evidence-based cardiovascular disease risk-modifying therapies. Methods: This study uses data from 3392 participants aged 30 to 65 years from the Dallas Heart Study, a probability-based, multiethnic sample of residents living in Dallas County, Texas. Three primary outcomes were examined:(1) diabetes prevalence,(2) adjusted odds ratios for detectable coronary calcium stratified by diabetes diagnosis status, and(3) rates of use of evidence-based cardiovascular disease risk-modifying therapies among subjects with diabetes stratified by diabetes diagnosis status. Results: The estimated prevalence of diabetes in Dallas County was 7.8%, with >40%of diabetic patients undiagnosed before participation in the Dallas Heart Study. Both previously diagnosed and previously undiagnosed diabetes were independently associated with the presence of coronary artery calcium(diagnosed: OR 3.55, 95%CI 1.56-8.05)(undiagnosed: OR 2.98, 95%CI 1.39-6.39). The rates of use of aspirin, angiotensin-converting enzyme inhibitors, and statins were suboptimal, and blood pressure and low-density lipoprotein cholesterol targets were rarely met, especially among subjects with previously undiagnosed diabetes. Conclusions: Diabetes is prevalent and is associated with subclinical cardiovascular disease; this association is present even at the time of diagnosis. Despite the cardiovascular risk associated with diabetes, evidence-based risk-modifying therapies continue to be underused, and therapeutic targets remain unmet, especially among people unaware of their diabetes diagnosis.
