Population Health Research Institute, Hamilton, Ontario, Canada.
Eur J Prev Cardiol. 2012 Aug;19(4):755-64. doi: 10.1177/1741826711409327. Epub 2011 May 6.
In an international prospective cohort study we assessed the relationship between glucose levels and incident cardiovascular events and death.
18,990 men and women were screened for entry into the DREAM clinical trial from 21 different countries. All had clinical and biochemical information collected at baseline, including an oral glucose tolerance test (OGTT), and were prospectively followed over a median (IQR) of 3.5 (3.0-4.0) years for incident cardiovascular (CV) events including coronary artery disease (CAD), stroke, congestive heart failure (CHF) requiring hospitalization, and death. After OGTT screening, 8000 subjects were classified as normoglycaemic, 8427 had impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), and 2563 subjects had newly diagnosed type 2 diabetes mellitus (DM). There were incident events in 491 individuals: 282 CAD, 54 strokes, 19 CHF, and 164 died. The annualized CV or death event rate was 0.79/100 person-years in the overall cohort, 0.51/100 person-years in normoglycaemics, 0.92/100 person-years among subjects with IFG and/or IGT at baseline, and 1.27/100 person-years among those with DM (p for trend <0.0001). Among all subjects, a 1 mmol/l increase in fasting plasma glucose (FPG) or a 2.52 mmol/l increase in the 2-h post-OGTT glucose was associated with a hazard ratio increase in the risk of CV events or death of 1.17 (95% CI 1.13-1.22).
In this large multiethnic cohort, the risk of CV events or death increased progressively among individuals who were normoglycaemic, IFG or IGT, and newly diagnosed diabetics. A 1 mmol/l increase in FPG was associated with a 17% increase in the risk of future CV events or death. Therapeutic or behavioural interventions designed to either prevent glucose levels from rising, or lower glucose among individuals with dysglycaemia should be evaluated.
在一项国际前瞻性队列研究中，我们评估了血糖水平与心血管事件和死亡的发生之间的关系。
从 21 个不同的国家筛选了 18990 名男性和女性参加 DREAM 临床试验。所有参与者在基线时均采集了临床和生化信息，包括口服葡萄糖耐量试验（OGTT），并前瞻性随访中位数（IQR）为 3.5（3.0-4.0）年，以观察心血管（CV）事件的发生情况，包括冠心病（CAD）、中风、充血性心力衰竭（CHF）需要住院治疗和死亡。OGTT 筛查后，8000 名受试者被归类为血糖正常，8427 名受试者有空腹血糖受损（IFG）或糖耐量受损（IGT），2563 名受试者有新诊断的 2 型糖尿病（DM）。491 名患者发生了事件：282 例 CAD、54 例中风、19 例 CHF 和 164 例死亡。整个队列的年化 CV 或死亡事件发生率为 0.79/100 人年，血糖正常者为 0.51/100 人年，基线时 IFG 和/或 IGT 患者为 0.92/100 人年，DM 患者为 1.27/100 人年（趋势检验 p<0.0001）。在所有受试者中，空腹血浆葡萄糖（FPG）升高 1mmol/L 或 OGTT 后 2 小时血糖升高 2.52mmol/L，CV 事件或死亡风险的危险比增加 1.17（95%CI 1.13-1.22）。
在这个大型的多民族队列中，血糖正常、IFG 或 IGT 以及新诊断为糖尿病的个体的 CV 事件或死亡风险逐渐增加。FPG 升高 1mmol/L 与未来 CV 事件或死亡风险增加 17%相关。应该评估旨在预防血糖升高或降低血糖的治疗或行为干预措施。
