First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
PLoS One. 2012;7(8):e42551. doi: 10.1371/journal.pone.0042551. Epub 2012 Aug 9.
Chronic hyperglycemia in type 2 diabetes increases the risk of microvascular events. However, there is continuing uncertainty about its effect on macrovascular outcomes and death. We conducted a meta-analysis of prospective studies to estimate the association of glycosylated hemoglobin level with the risk of all-cause mortality and cardiovascular outcomes among patients with type 2 diabetes.
METHODOLOGY/PRINCIPAL FINDINGS: We systematically searched the MEDLINE database through April 2011 by using Medical Subject Heading search terms and a standardized protocol. We included prospective cohort studies that reported data of glycosylated hemoglobin level on the risk of incident cardiovascular events and all-cause mortality. Relative risk estimates (continuous and categorical variables) were derived or abstracted from each cohort study. Twenty six studies were included in this analysis with a mean follow-up rang of 2.2-16 years. The pooled relative risk associated with a 1% increase in glycosylated hemoglobin level among patients with type 2 diabetes was 1.15 (95% CI, 1.11 to 1.20) for all-cause mortality, 1.17 (95% CI, 1.12 to 1.23) for cardiovascular disease, 1.15 (95% CI, 1.10 to 1.20) for coronary heart disease, 1.11 (95% CI, 1.05 to 1.18) for heart failure, 1.11 (95% CI, 1.06 to 1.17) for stroke, and 1.29 (95% CI, 1.18 to 1.40) for peripheral arterial disease, respectively. In addition, a positive dose-response trend existed between glycosylated hemoglobin level and cardiovascular outcomes.
CONCLUSIONS/SIGNIFICANCE: Chronic hyperglycemia is associated with an increased risk for cardiovascular outcomes and all-cause mortality among patients with type 2 diabetes, likely independently from other conventional risk factors.
2 型糖尿病患者的慢性高血糖会增加微血管事件的风险。然而，其对大血管结局和死亡的影响仍存在不确定性。我们对前瞻性研究进行了荟萃分析，以评估糖化血红蛋白水平与 2 型糖尿病患者全因死亡率和心血管结局风险的相关性。
方法/主要发现：我们通过使用医学主题词搜索词和标准化方案，系统地搜索了 MEDLINE 数据库，直到 2011 年 4 月。我们纳入了报告糖化血红蛋白水平与心血管事件和全因死亡率风险相关数据的前瞻性队列研究。相对风险估计值（连续和分类变量）是从每个队列研究中推导或提取出来的。这项分析共纳入了 26 项研究，平均随访时间为 2.2-16 年。在 2 型糖尿病患者中，糖化血红蛋白水平每增加 1%，全因死亡率的汇总相对风险为 1.15（95%置信区间，1.11 至 1.20），心血管疾病为 1.17（95%置信区间，1.12 至 1.23），冠心病为 1.15（95%置信区间，1.10 至 1.20），心力衰竭为 1.11（95%置信区间，1.05 至 1.18），中风为 1.11（95%置信区间，1.06 至 1.17），外周动脉疾病为 1.29（95%置信区间，1.18 至 1.40）。此外，糖化血红蛋白水平与心血管结局之间存在正剂量反应趋势。
结论/意义：慢性高血糖与 2 型糖尿病患者心血管结局和全因死亡率的增加相关，可能独立于其他传统危险因素。
