MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
Diabetologia. 2011 Feb;54(2):291-9. doi: 10.1007/s00125-010-1914-6. Epub 2010 Sep 23.
AIMS/HYPOTHESIS: Non-diabetic hyperglycaemia is usually not considered at all or is viewed as a binary risk category in isolation from other factors when quantifying cardiovascular risk. We argue that hyperglycaemia should be considered as a continuous risk factor and only in the context of other vascular risk factors. To examine the potential impact of hyperglycaemia on cardiovascular disease (CVD) risk, we calculated the absolute CVD risk in groups defined by different levels of HbA(1c) and other CVD risk factors.
We used data on 10,144 men and women from the European Prospective Investigation of Cancer-Norfolk cohort to calculate CVD rates across levels of HbA(1c) in groups characterised by different levels of traditional risk factors.
We found significant differences in CVD rates across levels of HbA(1c) in groups defined by different levels of the other risk factors. CVD rates for non-diabetic individuals with an HbA(1c) of <5.5% increased from 0.6 (95% CI 0.3-1.2) to 29.6 (95% CI 14.8-59.1) per 1,000 person-years when traditional CVD risk factors were added sequentially to the lowest risk reference group. In most cases, non-diabetic individuals with an HbA(1c) of <5.5% and high values for all other CVD risk factors had substantially higher absolute CVD rates than those with an HbA(1c) of 6.0% to 6.4% but with no other raised CVD risk factors (29.6 [95% CI 14.8-59.1] and 2.5 [95% CI 0.4-18.1], respectively). A history of diabetes significantly increased CVD risk over the non-diabetic hyperglycaemia range. Comparisons of CVD rates across tertiles of total cholesterol:HDL-cholesterol ratio or mean systolic blood pressure in groups characterised by different levels of other risk factors showed similar findings.
CONCLUSIONS/INTERPRETATION: In people with non-diabetic hyperglycaemia, cardiovascular risk is highly dependent on the presence of other CVD risk factors. Attention should be given not to whether an individual has 'pre-diabetes', 'hypertension' or 'hypercholesterolaemia', but to an integrated assessment of CVD risk, based on the combination of risk factors present and potential benefits of treatment.
目的/假设：在量化心血管风险时，非糖尿病性高血糖通常根本不被考虑，或者被视为一个与其他因素孤立的二元风险类别。我们认为，高血糖应被视为一个连续的风险因素，并且仅在其他血管风险因素的背景下考虑。为了研究高血糖对心血管疾病（CVD）风险的潜在影响，我们根据不同水平的糖化血红蛋白（HbA(1c)）和其他 CVD 风险因素计算了不同组别的绝对 CVD 风险。
我们使用来自欧洲癌症前瞻性调查-诺福克队列的 10144 名男性和女性的数据，根据不同水平的传统风险因素，计算不同 HbA(1c)水平组的 CVD 发生率。
我们发现，在根据其他风险因素的不同水平定义的组中，HbA(1c)水平的 CVD 发生率存在显著差异。当传统 CVD 风险因素被依次添加到最低风险参考组时，HbA(1c)水平<5.5%的非糖尿病个体的 CVD 发生率从每 1000 人年 0.6（95%CI 0.3-1.2）增加到 29.6（95%CI 14.8-59.1）。在大多数情况下，HbA(1c)水平<5.5%且其他所有 CVD 风险因素均较高的非糖尿病个体的绝对 CVD 发生率明显高于 HbA(1c)水平为 6.0%-6.4%但无其他升高的 CVD 风险因素的个体（分别为 29.6[95%CI 14.8-59.1]和 2.5[95%CI 0.4-18.1]）。糖尿病病史显著增加了非糖尿病性高血糖范围内的 CVD 风险。在根据其他风险因素的不同水平定义的组中，总胆固醇：高密度脂蛋白胆固醇比值或平均收缩压的三分位数之间的 CVD 发生率比较也显示出类似的结果。
结论/解释：在非糖尿病性高血糖患者中，心血管风险高度依赖于其他 CVD 风险因素的存在。关注的重点不应是个体是否患有“前驱糖尿病”、“高血压”或“高胆固醇血症”，而是基于存在的风险因素和治疗的潜在获益，对 CVD 风险进行综合评估。
