Cardiovascular disease incidence, mortality and case fatality related to diabetes and metabolic syndrome: A community-based prospective study (Ansung-Ansan cohort 2001-12)

• Published in: Journal of diabetes Vol. 7; no. 6; pp. 791 - 799
• Main Authors: Bae, Ji Cheol, Cho, Nam H., Suh, Sunghwan, Kim, Jae Hyeon, Hur, Kyu Yeon, Jin, Sang-Man, Lee, Moon-Kyu
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01.11.2015
• Subjects: Adult; Aged; cardiovascular disease; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - mortality; Cause of Death; diabetes; Diabetes Mellitus - diagnosis; Diabetes Mellitus - epidemiology; Diabetes Mellitus - mortality; Female; Humans; Incidence; Male; metabolic syndrome; Metabolic Syndrome - diagnosis; Metabolic Syndrome - epidemiology; Metabolic Syndrome - mortality; Middle Aged; Multivariate Analysis; Odds Ratio; Proportional Hazards Models; Prospective Studies; Republic of Korea - epidemiology; Risk Assessment; Risk Factors; Time Factors; 关键词：心血管疾病，糖尿病，代谢综合征; metabolic syndrome; cardiovascular disease; 关键词：心血管疾病，糖尿病，代谢综合征; diabetes
• ISSN: 1753-0393; 1753-0407; 1753-0407
• DOI: 10.1111/1753-0407.12248

Background We evaluated the separate and combined effect of metabolic syndrome (MS) and diabetes on incident cardiovascular disease (CVD), CVD mortality and case fatality risk (CFR). Methods 8898 subjects were categorized into four groups on the basis of the presence of MS and diabetes (with MS, with diabetes, with both or without either). We compared the development of CVD events, mortality and CFR. Results Over a mean follow‐up of 8.0 years, 690 subjects developed CVD. There were 434 deaths, of which 101 were from CVD. The presence of diabetes alone, MS alone, or both was associated with an increased risk for incident CVD and CVD mortality. Compared with the MS only group, the adjusted hazard ratio (HR) for CVD events and CVD mortality in the diabetes only group was 1.07 (95% confidence interval [CI] 0.77–1.48) and 2.02 (95% CI 0.99–1.72), respectively. Among individuals with diabetes, the presence of MS did not significantly increase CVD risk and CVD mortality. The adjusted odds ratio for CVD CFR, including adjustment for the presence of MS, in subjects with diabetes versus without diabetes was 2.11 (95% CI 1.34–3.31). Conclusions There was no difference in the risk of incident CVD between individuals with diabetes alone and MS alone, whereas CVD mortality was much higher in individuals with diabetes only. The presence of MS did not exhibit an additive effect on CVD risk and mortality in individuals with diabetes. Individuals with diabetes had a higher CVD case fatality regardless of the presence of MS. 摘要 背景： 我们评估了代谢综合征（metabolic syndrome，MS）与糖尿病对心血管疾病（cardiovascular disease，CVD）的发生率、死亡率以及病死率风险（case fatality risk，CFR）的单独以及综合影响。 方法： 根据MS与糖尿病的存在与否将8898名受试者分为4组（MS组、糖尿病组、同时合并这2种疾病组或者没有这2种疾病组）。对CVD事件的发生率、死亡率以及CFR进行了比较。 结果： 在平均8年的随访中，有690名受试者发生了CVD。共有434名受试者死亡，其中101名死于CVD。单独存在糖尿病、单独存在MS或者2种疾病都存在与CVD发生率以及CVD死亡率的风险增加都有相关性。与只有MS的受试者组相比，只有糖尿病的受试者组校正后的CVD事件以及CVD死亡率的危险比（HR）分别为1.07（95%置信区间[CI]为0.77‐1.48）与2.02（95% CI为0.99‐1.72）。在糖尿病患者中，存在MS并不会显著增加CVD风险与CVD死亡率。校正后的CVD CFR优势比，包括校正存在MS后，糖尿病受试者与非糖尿病受试者相比的优势比为2.11（95% CI为1.34‐3.31）。 结论： 在单独存在糖尿病的患者与单独存在MS的患者之间发生CVD的风险没有差异，然而单独存在糖尿病的患者的CVD死亡率明显更高。在糖尿病患者中存在MS并不会对CVD风险与死亡率造成额外的影响。糖尿病患者无论是否存在MS其CVD病死率都更高。