Khaw Kay-Tee, Wareham Nicholas
School of Clinical Medicine, University of Cambridge, UK.
Curr Opin Lipidol. 2006 Dec;17(6):637-43. doi: 10.1097/MOL.0b013e3280106b95.
Diabetes mellitus is an established risk factor for cardiovascular disease. This review examines glycated hemoglobin, an indicator of long-term average blood glucose concentrations, in risk prediction for cardiovascular disease.
Glycated hemoglobin concentrations predict cardiovascular disease risk in people with diabetes, and trial data suggest that good blood glucose control is associated with reduction in cardiovascular disease. Elevated glycated hemoglobin levels below the thresholds accepted for diabetes are also associated with increasing cardiovascular disease risk independent of classical risk factors in a continuous relationship across the whole normal distribution. A 1% increase in absolute concentrations of glycated hemoglobin is associated with about 10-20% increase in cardiovascular disease risk. The continuous relationship is most evident for coronary heart disease in men; the shape of the risk curve is less clear for women and for other cardiovascular endpoints such as stroke or peripheral vascular disease.
Glycated hemoglobin concentration predicts cardiovascular risk both in people with diabetes and in the general population, and may help identify individuals at higher risk of cardiovascular disease for targeted interventions, including blood pressure or cholesterol reduction. Understanding the nature of this relationship may inform new preventive and therapeutic interventions.
糖尿病是心血管疾病公认的危险因素。本综述探讨糖化血红蛋白这一长期平均血糖浓度指标在心血管疾病风险预测中的作用。
糖化血红蛋白浓度可预测糖尿病患者的心血管疾病风险，试验数据表明良好的血糖控制与心血管疾病风险降低相关。糖化血红蛋白水平升高但低于糖尿病诊断阈值时，也与心血管疾病风险增加相关，且与经典危险因素无关，在整个正常分布范围内呈连续关系。糖化血红蛋白绝对浓度每增加1%，心血管疾病风险约增加10% - 20%。这种连续关系在男性冠心病患者中最为明显；女性以及中风或外周血管疾病等其他心血管终点的风险曲线形状则不太清晰。
糖化血红蛋白浓度可预测糖尿病患者和普通人群的心血管风险，并可能有助于识别心血管疾病高风险个体，以便进行有针对性的干预，包括降低血压或胆固醇。了解这种关系的本质可能为新的预防和治疗干预提供依据。
