Prevalence of Atherosclerotic Cardiovascular Disease, Heart Failure, and Chronic Kidney Disease in Patients with Type 2 Diabetes Mellitus: A Primary Care Research Network-based Study.
Geert Goderis, Bert Vaes, Pavlos Mamouris, Eline van Craeyveld, Chantal Mathieu
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引用次数: 6
Abstract
Aims: This study aims to assess the prevalence of atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), chronic kidney disease (CKD), and their combined presence in type 2 diabetes (T2D) patients in primary care for whom the 2019 ADA/EASD consensus update "Management of Hyperglycemia in Type 2 Diabetes" recommends GLP-1 receptor agonists (GLP-1RA) or sodium-glucose cotransporter-2 inhibitors (SGLT-I) as first-line medications after metformin.
Methods: Data were obtained in 2015 from Intego, a morbidity registration network of 111 general practitioners (GPs) working in 48 practices and including 123 261 registered patients.
Results: Of 123 261 patients, 9616 had T2D. Of these patients, 4200 (43.7%) presented with ASCVD and/or CKD and/or HF. Specifically, 3348 (34.8%) patients had ASCVD, 388 (4.0%) had heart failure, and 1402 (14.6%) had CKD. Compared to patients without any of these comorbidities, patients with at least 1 of these conditions were older (69.7 ±12.6 vs. 63.1±12.5 years), had higher LDL-C values (104.2±35.8 mg/dl vs. 97.2±37.7) and less frequently achieved the systolic blood pressure target of 140 mm Hg (53 vs. 61%) (all p<0.001). Comorbid patients also had significantly more other comorbidities, such as dementia or cancer; received more recommended medications, such as statins; and received less metformin. Most patients with HF (325; 3.4%) had ASCVD (114; 1.2%), CKD (76; 0.8%), or both (135; 1.4%). In total, 478 patients with CKD (5.0%) also had ASCVD.
Conclusions: At the primary care level, 44% of T2D patients suffer from ASCVD, CKD, and/or HF, and thus qualify for GLP-1RA or SGLT2-I therapy.
目的:本研究旨在评估动脉粥样硬化性心血管疾病(ASCVD)、心力衰竭(HF)、慢性肾脏疾病(CKD)的患病率及其在2型糖尿病(T2D)患者中的联合存在，2019年ADA/EASD共识更新“2型糖尿病高血糖的管理”推荐GLP-1受体兴奋剂(GLP-1RA)或钠-葡萄糖共转运蛋白-2抑制剂(SGLT-I)作为二甲双胍后的一线药物。方法:2015年数据来自Intego，这是一个由48家诊所的111名全科医生(gp)组成的发病率登记网络，包括123261名登记患者。结果:123261例患者中有9616例发生T2D。在这些患者中，4200例(43.7%)表现为ASCVD和/或CKD和/或HF。具体来说，3348例(34.8%)患者患有ASCVD, 388例(4.0%)患者患有心力衰竭，1402例(14.6%)患者患有CKD。与没有这些合并症的患者相比，至少有1种合并症的患者年龄较大(69.7±12.6岁vs 63.1±12.5岁)，LDL-C值较高(104.2±35.8 mg/dl vs 97.2±37.7)，收缩压达到140 mm Hg目标的频率较低(53% vs 61%)(所有结论:在初级保健水平，44%的T2D患者患有ASCVD、CKD和/或HF，因此符合GLP-1RA或SGLT2-I治疗的条件。
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