关键词: 糖尿病, 2型, 社区管理, 改良FRS评分, 心血管事件

Abstract: Background　Type 2 diabetes（T2DM） patients have elevated risk of cardiovascular disease（CVD） and death，but CVD events in them with different levels of CVD risk are rarely reported. Objective　To observe the changes of CVD risk in T2DM patients receiving long-term mutifactorial interventions living in urban communities of Beijing. Methods　A total of 2 926 T2DM patients from 15 communities of Beijing were enrolled in 2008，including 824 without complications，1 267 with hypertension，and 835 with CVD with different levels of 10-year CVD risk〔low，medium and high（<10%，10%-20%，>20%）〕 stratified by using the improved Framingham Risk Score（I-FRS）. All patients received a follow-up with standardized management as of December 2017 to assess the changes in cardiovascular risk during this period，including clinical characteristics，I-FRS and endpoint events. Cox regression model was used to analyze the influencing factors of endpoint events. Results　Among patients with medium 10-year CVD risk，those with CVD had greater mean age，longer mean duration of T2DM and higher mean baseline blood pressure than those with only diabetes or with hypertension（P<0.01）. Those with only diabetes showed much higher mean baseline levels of fasting blood glucose（FPG），glycosylated hemoglobin（HbA1c），total cholesterol（TC），low-density lipoprotein cholesterol（LDL-C） compared with those complicated with CVD or hypertension（P<0.01）. Among patients with high 10-year CVD risk，those with CVD had greater mean age than those with only diabetes or with hypertension（P<0.01）. Those with only diabetes showed much lower mean baseline systolic blood pressure，and much higher mean baseline FPG，HbA1c，TC and LDL-C than those with CVD or hypertension （P<0.01）. Among patients with medium 10-year CVD risk，the levels of blood pressure，TC and LDL-C in CVD group and HTN group were significant decrease when compared with baseline. Meantime，in DM group，the levels of diastolic blood pressure，FPG，HbA1c，TC and LDL-C were much lower than baseline. Compared with baseline in patients with high 10-year CVD risk，CVD group and HTN group had much lower levels in blood pressure，FPG，TG and LDL-C；while in DM group，the levels of HbA1c and TC significant decreased at the end of follow-up. In those with medium and high 10-year CVD risk，the I-FRS at the end of follow-up changed significantly compared with the baseline levels，regardless of having CVD or hypertension or not（P<0.05）. Those with CVD or hypertension showed significant elevated cumulative incidence of all-cause death and CVD events compared with those without complications（P<0.017）. In Cox regression analyses，after adjusting for age and sex，increased risk of endpoint events was found in those with hypertension（HR=1.542） and in those with CVD（HR=1.923）. Conclusion　The outcome of community-living T2DM patients with CVD was poor，so it is important to deliver multifactorial interventions to them to reduce CVD risk factors. Attentions should be paid to those with high I-FRS，regardless of having complications or not，to conduct individualized assessment for them to reduce CVD risk factors.

Key words: Diabetes mellitus, type 2；Community management；Improved Framingham risk scores；Cardiovascular events