Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK.
Lancet. 2010 Jun 26;375(9733):2215-22. doi: 10.1016/S0140-6736(10)60484-9.
Uncertainties persist about the magnitude of associations of diabetes mellitus and fasting glucose concentration with risk of coronary heart disease and major stroke subtypes. We aimed to quantify these associations for a wide range of circumstances.
We undertook a meta-analysis of individual records of diabetes, fasting blood glucose concentration, and other risk factors in people without initial vascular disease from studies in the Emerging Risk Factors Collaboration. We combined within-study regressions that were adjusted for age, sex, smoking, systolic blood pressure, and body-mass index to calculate hazard ratios (HRs) for vascular disease.
Analyses included data for 698 782 people (52 765 non-fatal or fatal vascular outcomes; 8.49 million person-years at risk) from 102 prospective studies. Adjusted HRs with diabetes were: 2.00 (95% CI 1.83-2.19) for coronary heart disease; 2.27 (1.95-2.65) for ischaemic stroke; 1.56 (1.19-2.05) for haemorrhagic stroke; 1.84 (1.59-2.13) for unclassified stroke; and 1.73 (1.51-1.98) for the aggregate of other vascular deaths. HRs did not change appreciably after further adjustment for lipid, inflammatory, or renal markers. HRs for coronary heart disease were higher in women than in men, at 40-59 years than at 70 years and older, and with fatal than with non-fatal disease. At an adult population-wide prevalence of 10%, diabetes was estimated to account for 11% (10-12%) of vascular deaths. Fasting blood glucose concentration was non-linearly related to vascular risk, with no significant associations between 3.90 mmol/L and 5.59 mmol/L. Compared with fasting blood glucose concentrations of 3.90-5.59 mmol/L, HRs for coronary heart disease were: 1.07 (0.97-1.18) for lower than 3.90 mmol/L; 1.11 (1.04-1.18) for 5.60-6.09 mmol/L; and 1.17 (1.08-1.26) for 6.10-6.99 mmol/L. In people without a history of diabetes, information about fasting blood glucose concentration or impaired fasting glucose status did not significantly improve metrics of vascular disease prediction when added to information about several conventional risk factors.
Diabetes confers about a two-fold excess risk for a wide range of vascular diseases, independently from other conventional risk factors. In people without diabetes, fasting blood glucose concentration is modestly and non-linearly associated with risk of vascular disease.
British Heart Foundation, UK Medical Research Council, and Pfizer.
目前对于糖尿病和空腹血糖浓度与冠心病和主要脑卒中亚型风险之间关联的程度仍存在不确定性。我们旨在针对各种情况量化这些关联。
我们对来自新兴风险因素协作研究中无初始血管疾病的人群的糖尿病、空腹血糖浓度和其他风险因素的个体记录进行了荟萃分析。我们结合了各研究中的调整年龄、性别、吸烟、收缩压和体重指数的回归分析，计算了血管疾病的风险比（HR）。
分析包括来自 102 项前瞻性研究的 698782 人（52765 例非致死性或致死性血管结局；849 万人年的风险）的数据。糖尿病的调整 HR 为：冠心病 2.00（95%CI 1.83-2.19）；缺血性脑卒中 2.27（1.95-2.65）；出血性脑卒中 1.56（1.19-2.05）；未分类脑卒中 1.84（1.59-2.13）；其他血管性死亡 1.73（1.51-1.98）。进一步调整脂质、炎症或肾脏标志物后，HR 变化不大。女性的 HR 高于男性，在 40-59 岁时高于 70 岁及以上，且与致死性疾病相比，非致死性疾病的 HR 更高。在成人人群中，10%的患病率估计占血管性死亡的 11%（10-12%）。空腹血糖浓度与血管风险呈非线性相关，在 3.90mmol/L 与 5.59mmol/L 之间没有显著关联。与 3.90-5.59mmol/L 的空腹血糖浓度相比，冠心病的 HR 为：<3.90mmol/L 时为 1.07（0.97-1.18）；5.60-6.09mmol/L 时为 1.11（1.04-1.18）；6.10-6.99mmol/L 时为 1.17（1.08-1.26）。在没有糖尿病病史的人群中，当添加关于几个传统危险因素的信息时，空腹血糖浓度或空腹血糖受损状态的信息对血管疾病预测指标的改善并不显著。
糖尿病使多种血管疾病的风险增加约两倍，且独立于其他传统危险因素。在没有糖尿病的人群中，空腹血糖浓度与血管疾病风险呈适度非线性相关。
糖尿病使多种血管疾病的风险增加约两倍，且独立于其他传统危险因素。在没有糖尿病的人群中，空腹血糖浓度与血管疾病风险呈适度非线性相关。
英国心脏基金会、英国医学研究理事会和辉瑞公司。
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