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糖尿病と米国の成人における心臓病死亡率の低下
1National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA.
JAMA
|April 20, 1999
まとめ
心臓病による死亡率は,糖尿病の男性では減少し,糖尿病の女性では増加した. これらの傾向は,心血管疾患の介入が糖尿病患者,特に女性に対して効果が低いことを示唆しています.
科学分野:
- 心血管疾患の疫学について
- 糖尿病に関する研究
- 公衆衛生は公衆衛生である.
背景:
- 冠動脈性心疾患の死亡率は,米国では30年以上にわたって著しく減少しています.
- この減少が糖尿病患者にも及ぶかどうかは不明である.
研究 の 目的:
- 糖尿病と糖尿病のない成人の全原因,心疾患,心不全性疾患による死亡率の傾向を比較する.
- 2つの異なるコホート間の死亡率のタイムトレンドを分析する.
主な方法:
- 全国保健栄養調査 (NHANES I) とそのフォローアップ調査から得られたデータを活用した.
- 1971年から1975年,そして1982年から1984年のコホートにおける死亡率の比較 (1000人/年)
- 死亡率の見通しのフォローアップは平均8〜9年でした.
主要な成果:
- 糖尿病のない男性では,心臓病による死亡率が36.4%低下し,糖尿病の男性は13.1%減少しただけであった.
- 非糖尿病の女性は27%減少し,糖尿病の女性は心臓病による死亡率が23%増加しました.
- 同様のパターンは,全原因および心不全性疾患の死亡率でも観察されました.
結論:
- 一般人群で観察された心臓病死亡率の減少は,糖尿病患者では効果が低い可能性があります.
- 心血管疾患のリスク因子の減少と治療法の改善は,糖尿病患者,特に女性に対して,より少ない利益をもたらすように見える.
- 糖尿病患者の心血管疾患のアウトカムにおける格差を理解し,対処するためにさらなる研究が必要です.
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