Background:The role of diabetes in the development of valvular heart disease, and, in particular, the relation with risk factor control, has not been extensively studied.Methods:We included 715 143 patients with diabetes registered in the Swedish National Diabetes Register and compared them with 2 732 333 matched controls randomly selected from the general population. First, trends were analyzed with incidence rates and Cox regression, which was also used to assess diabetes as a risk factor compared with controls, and, second, separately in patients with diabetes according to the presence of 5 risk factors.Results:The incidence of valvular outcomes is increasing among patients with diabetes and the general population. In type 2 diabetes, systolic blood pressure, body mass index, and renal function were associated with valvular lesions. Hazard ratios for patients with type 2 diabetes who had nearly all risk factors within target ranges, compared with controls, were as follows: aortic stenosis 1.34 (95% CI, 1.31–1.38), aortic regurgitation 0.67 (95% CI, 0.64–0.70), mitral stenosis 1.95 (95% CI, 1.76–2.20), and mitral regurgitation 0.82 (95% CI, 0.79–0.85). Hazard ratios for patients with type 1 diabetes and nearly optimal risk factor control were as follows: aortic stenosis 2.01 (95% CI, 1.58–2.56), aortic regurgitation 0.63 (95% CI, 0.43–0.94), and mitral stenosis 3.47 (95% CI, 1.37–8.84). Excess risk in patients with type 2 diabetes for stenotic lesions showed hazard ratios for aortic stenosis 1.62 (95% CI, 1.59–1.65), mitral stenosis 2.28 (95% CI, 2.08–2.50), and excess risk in patients with type 1 diabetes showed hazard ratios of 2.59 (95% CI, 2.21–3.05) and 11.43 (95% CI, 6.18–21.15), respectively. Risk for aortic and mitral regurgitation was lower in type 2 diabetes: 0.81 (95% CI, 0.78–0.84) and 0.95 (95% CI, 0.92–0.98), respectively.Conclusions:Individuals with type 1 and 2 diabetes have greater risk for stenotic lesions, whereas risk for valvular regurgitation was lower in patients with type 2 diabetes. Patients with well-controlled cardiovascular risk factors continued to display higher risk for valvular stenosis, without a clear stepwise decrease in risk between various degrees of risk factor control.

中文翻译：

---

1 型和 2 型糖尿病患者的左侧退行性瓣膜病

背景：糖尿病在瓣膜性心脏病发展中的作用，尤其是与危险因素控制的关系，尚未得到广泛研究。方法：我们纳入了在瑞典国家糖尿病登记处注册的 715143 名糖尿病患者，并进行比较他们与从一般人群中随机选择的 2 732 333 个匹配的对照。首先，使用发病率和 Cox 回归分析趋势，与对照组相比，这也用于评估糖尿病作为危险因素，其次，根据 5 种危险因素的存在分别对糖尿病患者进行分析。结果：糖尿病患者和普通人群的瓣膜结局正在增加。在 2 型糖尿病中，收缩压、体重指数和肾功能与瓣膜病变相关。与对照组相比，几乎所有危险因素都在目标范围内的 2 型糖尿病患者的危险比如下：主动脉瓣狭窄 1.34（95% CI，1.31-1.38），主动脉瓣反流 0.67（95% CI，0.64-0.70） )、二尖瓣狭窄 1.95（95% CI，1.76–2.20）和二尖瓣反流 0.82（95% CI，0.79–0.85）。1 型糖尿病患者的风险比和接近最佳的危险因素控制如下：主动脉瓣狭窄 2.01（95% CI，1.58-2.56），主动脉瓣反流 0.63（95% CI，0.43-0.94）和二尖瓣狭窄 3.47（95 % 置信区间，1.37–8.84）。2 型糖尿病患者的狭窄病变风险过高显示主动脉瓣狭窄的风险比为 1.62（95% CI，1.59-1.65），二尖瓣狭窄为 2.28（95% CI，2.08-2.50），1 型糖尿病患者的风险过高显示风险比为 2.59 (95% CI, 2.21–3.05) 和 11.43 (95% CI, 6. 18-21.15），分别。2 型糖尿病患者主动脉和二尖瓣反流的风险较低：分别为 0.81（95% CI，0.78-0.84）和 0.95（95% CI，0.92-0.98）。结论：1 型和 2 型糖尿病患者发生狭窄病变，而 2 型糖尿病患者瓣膜反流的风险较低。心血管危险因素控制良好的患者继续表现出更高的瓣膜狭窄风险，但在不同程度的危险因素控制之间风险没有明显的逐步降低。而 2 型糖尿病患者瓣膜反流的风险较低。心血管危险因素控制良好的患者继续表现出更高的瓣膜狭窄风险，但在不同程度的危险因素控制之间风险没有明显的逐步降低。而 2 型糖尿病患者瓣膜反流的风险较低。心血管危险因素控制良好的患者继续表现出更高的瓣膜狭窄风险，但在不同程度的危险因素控制之间风险没有明显的逐步降低。