Danaei Goodarz, Lawes Carlene M M, Vander Hoorn Stephen, Murray Christopher J L, Ezzati Majid
Harvard School of Public Health, Boston, MA 02115, USA.
Lancet. 2006 Nov 11;368(9548):1651-9. doi: 10.1016/S0140-6736(06)69700-6.
Cardiovascular mortality risk increases continuously with blood glucose, from concentrations well below conventional thresholds used to define diabetes. We aimed to quantify population-level effects of all higher-than-optimum concentrations of blood glucose on mortality from ischaemic heart disease and stroke worldwide.
We used population distribution of fasting plasma glucose to measure exposure to higher-than-optimum blood glucose. We collated exposure data in 52 countries from individual-level records in population health surveys, systematic reviews, and data provided by investigators. Relative risks for ischaemic heart disease and stroke mortality were from a meta-analysis of more than 200,000 participants in the Asia-Pacific region, with adjustment for other cardiovascular risk factors.
In addition to 959,000 deaths directly assigned to diabetes, 1 490,000 deaths from ischaemic heart disease and 709,000 from stroke were attributable to high blood glucose, accounting for 21% and 13% of all deaths from these conditions. 1.8 million of these 2.2 million cardiovascular deaths (84%) were in low-and-middle-income countries (1,224,000 for ischaemic heart disease, 623,000 for stroke). 792,000 (53%) of deaths from ischaemic heart disease and 345,000 (49%) from stroke that were attributable to high blood glucose were in men. Largest numbers of deaths attributable to this risk factor from ischaemic heart disease were in low-and-middle-income countries of South Asia (548,000) and Europe and Central Asia (313,000), and from stroke in South Asia (215,000) and East Asia and Pacific (190,000).
Higher-than-optimum blood glucose is a leading cause of cardiovascular mortality in most world regions. Programmes for cardiovascular risk and diabetes management and control at the population level need to be more closely integrated.
心血管疾病死亡率风险随血糖升高而持续增加，即便血糖浓度远低于用于定义糖尿病的传统阈值。我们旨在量化全球所有高于最佳浓度的血糖对缺血性心脏病和中风死亡率的人群水平影响。
我们利用空腹血糖的人群分布来衡量暴露于高于最佳血糖水平的情况。我们从52个国家的人群健康调查中的个体记录、系统评价以及研究者提供的数据中整理暴露数据。缺血性心脏病和中风死亡率的相对风险来自对亚太地区超过200,000名参与者的荟萃分析，并对其他心血管风险因素进行了调整。
除了直接归因于糖尿病的959,000例死亡外，缺血性心脏病导致的1490,000例死亡和中风导致的709,000例死亡可归因于高血糖，分别占这些疾病所致所有死亡的21%和13%。这220万例心血管死亡中的180万例（84%）发生在低收入和中等收入国家（缺血性心脏病1,224,000例，中风623,000例）。缺血性心脏病归因于高血糖的死亡中有792,000例（53%）和中风归因于高血糖的死亡中有345,000例（49%）发生在男性中。缺血性心脏病归因于该风险因素的死亡人数最多的是南亚（548,000例）以及欧洲和中亚（313,000例）的低收入和中等收入国家，中风归因于该风险因素的死亡人数最多的是南亚（215,000例）以及东亚和太平洋地区（190,000例）。
高于最佳水平的血糖是世界上大多数地区心血管疾病死亡率的主要原因。需要更紧密地整合人群层面的心血管疾病风险及糖尿病管理与控制项目。
