PDF(Pubmed)
Abstract：
Increased risk of severe tachyarrhythmias is reported in patients with type 2 diabetes mellitus (T2DM). The aim of this study was to explore if treatment with cardiac implantable electronic device (CIED) such as implantable cardioverter defibrillator (ICD), cardiac resynchronization therapy- pacemaker and -defibrillator (CRT-P/CRT-D) differed in patients with vs. without T2DM. A secondary aim was to identify patient characteristics indicating an increased CIED treatment.
416 162 adult patients with T2DM from the Swedish National Diabetes Registry and 2 081 087 controls from the Swedish population, matched for age, sex and living area, were included between 1/1/1998 and 31/12/2012 and followed until 31/12/2013. They were compared regarding prevalence of ventricular tachycardia (VT) at baseline and the risk of receiving a CIED during follow-up. Multivariable Cox regression analysis was performed to estimate the risk of CIED-treatment and factors identifying patients with such risk.
Ventricular fibrillation (VF) (0.1% vs 0.0004%) and (VT) (0.2% vs. 0.1%) were more frequent among patients with T2DM compared to controls. CIED-treatment was significantly increased in patients with T2DM both in unadjusted and adjusted analyses. HR and 95% CI, after adjustment for sex, age, marital status, income, education, country of birth, coronary artery disease and congestive heart failure, were 1.32 [1.21-1.45] for ICD, 1.74 [1.55-1.95] for CRT-P and 1.69 [1.43-1.99] for CRT-D. Blood-pressure and lipid lowering therapies were independent risk factors associated to receiving CIED, while female sex was protective.
Although the proportion of VT/VF was low, patients with T2DM had a higher prevalence of these conditions and increased risk for treatment with CIED compared to controls. This underlines the importance of recognizing that T2DM patients have an increased need of CIED.
416 162 adult patients with T2DM from the Swedish National Diabetes Registry and 2 081 087 controls from the Swedish population, matched for age, sex and living area, were included between 1/1/1998 and 31/12/2012 and followed until 31/12/2013. They were compared regarding prevalence of ventricular tachycardia (VT) at baseline and the risk of receiving a CIED during follow-up. Multivariable Cox regression analysis was performed to estimate the risk of CIED-treatment and factors identifying patients with such risk.
Ventricular fibrillation (VF) (0.1% vs 0.0004%) and (VT) (0.2% vs. 0.1%) were more frequent among patients with T2DM compared to controls. CIED-treatment was significantly increased in patients with T2DM both in unadjusted and adjusted analyses. HR and 95% CI, after adjustment for sex, age, marital status, income, education, country of birth, coronary artery disease and congestive heart failure, were 1.32 [1.21-1.45] for ICD, 1.74 [1.55-1.95] for CRT-P and 1.69 [1.43-1.99] for CRT-D. Blood-pressure and lipid lowering therapies were independent risk factors associated to receiving CIED, while female sex was protective.
Although the proportion of VT/VF was low, patients with T2DM had a higher prevalence of these conditions and increased risk for treatment with CIED compared to controls. This underlines the importance of recognizing that T2DM patients have an increased need of CIED.
摘要：
背景：据报道，2型糖尿病（T2DM）患者发生严重快速性心律失常的风险增加。这项研究的目的是探讨是否使用心脏植入式电子设备（CIED），如植入式心脏复律除颤器（ICD），心脏再同步化治疗-起搏器和除颤器（CRT-P/CRT-D）的患者与没有T2DM。次要目的是确定表明CIED治疗增加的患者特征。
方法：416162名来自瑞典国家糖尿病登记处的T2DM成年患者和2.081087名来自瑞典人群的对照。年龄相匹配，性和生活区，在1998年1月1日至2012年12月31日期间纳入，并随访至2013年12月31日。比较了基线室性心动过速（VT）的患病率和随访期间接受aCIED的风险。进行多变量Cox回归分析以评估CIED治疗的风险以及确定具有此类风险的患者的因素。
结果：室颤（VF）（0.1％vs.0.0004％）和（VT）（0.2％vs.与对照组相比，T2DM患者中0.1％）的频率更高。在未调整和调整的分析中，T2DM患者的CIED治疗显着增加。HR和95%CI，在性别调整后，年龄,婚姻状况,收入,教育,出生国,冠状动脉疾病和充血性心力衰竭，ICD为1.32[1.21-1.45]，CRT-P为1.74[1.55-1.95]，CRT-D为1.69[1.43-1.99]血压和降脂治疗是接受CIED的独立危险因素，而女性是保护性的。
结论：尽管VT/VF的比例较低，与对照组相比,T2DM患者这些疾病的患病率较高,接受CIED治疗的风险也较高.这强调了认识到T2DM患者对CIED的需求增加的重要性。
方法：416162名来自瑞典国家糖尿病登记处的T2DM成年患者和2.081087名来自瑞典人群的对照。年龄相匹配，性和生活区，在1998年1月1日至2012年12月31日期间纳入，并随访至2013年12月31日。比较了基线室性心动过速（VT）的患病率和随访期间接受aCIED的风险。进行多变量Cox回归分析以评估CIED治疗的风险以及确定具有此类风险的患者的因素。
结果：室颤（VF）（0.1％vs.0.0004％）和（VT）（0.2％vs.与对照组相比，T2DM患者中0.1％）的频率更高。在未调整和调整的分析中，T2DM患者的CIED治疗显着增加。HR和95%CI，在性别调整后，年龄,婚姻状况,收入,教育,出生国,冠状动脉疾病和充血性心力衰竭，ICD为1.32[1.21-1.45]，CRT-P为1.74[1.55-1.95]，CRT-D为1.69[1.43-1.99]血压和降脂治疗是接受CIED的独立危险因素，而女性是保护性的。
结论：尽管VT/VF的比例较低，与对照组相比,T2DM患者这些疾病的患病率较高,接受CIED治疗的风险也较高.这强调了认识到T2DM患者对CIED的需求增加的重要性。
