Eastwood S V, Tillin T, Mayet J, Shibata D K, Wright A, Heasman J, Beauchamp N, Forouhi N G, Hughes A D, Chaturvedi N
UCL Institute of Cardiovascular Science, University College London, London.
National Heart and Lung Institute, Imperial College London, London.
Diabet Med. 2016 Mar;33(3):340-7. doi: 10.1111/dme.12895. Epub 2015 Oct 19.
We contrasted impaired glucose regulation (prediabetes) prevalence, defined according to oral glucose tolerance test or HbA1c values, and studied cross-sectional associations between prediabetes and subclinical/clinical cardiovascular disease (CVD) in a cohort of European and South Asian origin.
For 682 European and 520 South Asian men and women, aged 58-85 years, glycaemic status was determined by oral glucose tolerance test or HbA1c thresholds. Questionnaires, record review, coronary artery calcification scores and cerebral magnetic resonance imaging established clinical plus subclinical coronary heart and cerebrovascular disease.
Prediabetes was more prevalent in South Asian participants when defined by HbA1c rather than by oral glucose tolerance test criteria. Accounting for age, sex, smoking, systolic blood pressure, triglycerides and waist-hip ratio, prediabetes was associated with coronary heart disease and cerebrovascular disease in European participants, most obviously when defined by HbA1c rather than by oral glucose tolerance test [odds ratios for HbA1c -defined prediabetes 1.60 (95% CI 1.07, 2.39) for coronary heart disease and 1.57 (95% CI 1.00, 2.51) for cerebrovascular disease]. By contrast, non-significant associations were present between oral glucose tolerance test-defined prediabetes only and coronary heart disease [odds ratio 1.41 (95% CI 0.84, 2.36)] and HbA1c -defined prediabetes only and cerebrovascular disease [odds ratio 1.39 (95% CI 0.69, 2.78)] in South Asian participants. Prediabetes defined by HbA1c or oral glucose tolerance test criteria was associated with cardiovascular disease (defined as coronary heart and/or cerebrovascular disease) in Europeans [odds ratio 1.95 (95% CI 1.31, 2.91) for HbA1c prediabetes criteria] but not in South Asian participants [odds ratio 1.00 (95% CI 0.62, 2.66); ethnicity interaction P = 0.04].
Prediabetes appeared to be less associated with cardiovascular disease in the South Asian than in the European group. These findings have implications for screening, and early cardiovascular prevention strategies in South Asian populations.
我们对比了根据口服葡萄糖耐量试验或糖化血红蛋白（HbA1c）值定义的血糖调节受损（糖尿病前期）患病率，并在一组欧洲和南亚裔人群中研究了糖尿病前期与亚临床/临床心血管疾病（CVD）之间的横断面关联。
对于682名欧洲人和520名南亚裔男性及女性，年龄在58 - 85岁之间，通过口服葡萄糖耐量试验或HbA1c阈值来确定血糖状态。通过问卷调查、记录回顾、冠状动脉钙化评分和脑磁共振成像来确定临床及亚临床冠心病和脑血管疾病情况。
当根据HbA1c而非口服葡萄糖耐量试验标准定义时，糖尿病前期在南亚参与者中更为普遍。在考虑年龄、性别、吸烟、收缩压、甘油三酯和腰臀比后，糖尿病前期与欧洲参与者的冠心病和脑血管疾病相关，当根据HbA1c而非口服葡萄糖耐量试验定义时最为明显[HbA1c定义的糖尿病前期患冠心病的比值比为1.60（95%可信区间1.07，2.39），患脑血管疾病的比值比为1.57（95%可信区间1.00，2.51）]。相比之下，在南亚参与者中，仅口服葡萄糖耐量试验定义的糖尿病前期与冠心病之间的关联不显著[比值比1.41（95%可信区间0.并在一组欧洲和南亚裔人群中研究了糖尿病前期与亚临床/临床心血管疾病（CVD）之间的横断面关联。
对于682名欧洲人和520名南亚裔男性及女性，年龄在58 - 85岁之间，通过口服葡萄糖耐量试验或HbA1c阈值来确定血糖状态。通过问卷调查、记录回顾、冠状动脉钙化评分和脑磁共振成像来确定临床及亚临床冠心病和脑血管疾病情况。
当根据HbA1c而非口服葡萄糖耐量试验标准定义时，糖尿病前期在南亚参与者中更为普遍。在考虑年龄、性别、吸烟、收缩压、甘油三酯和腰臀比后，糖尿病前期与欧洲参与者的冠心病和脑血管疾病相关，当根据HbA1c而非口服葡萄糖耐量试验定义时最为明显[HbA1c定义的糖尿病前期患冠心病的比值比为1.60（95%可信区间1.07，2.39），患脑血管疾病的比值比为1.57（95%可信区间1.00，2.51）]。相比之下，在南亚参与者中，仅口服葡萄糖耐量试验定义的糖尿病前期与冠心病之间的关联不显著[比值比1.41（95%可信区间0.84，2.36）]，仅HbA1c定义的糖尿病前期与脑血管疾病之间的关联也不显著[比值比1.39（95%可信区间0.69，2.78）]。根据HbA1c或口服葡萄糖耐量试验标准定义的糖尿病前期与欧洲人的心血管疾病（定义为冠心病和/或脑血管疾病）相关[HbA1c糖尿病前期标准的比值比为1.95（95%可信区间1.31，2.91）]，但在南亚参与者中并非如此[比值比1.00（95%可信区间0.62，2.66）；种族交互作用P = 0.04]。
糖尿病前期在南亚人群中与心血管疾病的关联似乎比在欧洲人群中弱。这些发现对南亚人群的筛查和早期心血管预防策略具有启示意义。 84，2.36）]，仅HbA1c定义的糖尿病前期与脑血管疾病之间的关联也不显著[比值比1.39（95%可信区间0.69，2.78）]。根据HbA1c或口服葡萄糖耐量试验标准定义的糖尿病前期与欧洲人的心血管疾病（定义为冠心病和/或脑血管疾病）相关[HbA1c糖尿病前期标准的比值比为1.95（95%可信区间1.31，2.91）]，但在南亚参与者中并非如此[比值比1.00（95%可信区间0.62，2.66）；种族交互作用P = 0.04]。
糖尿病前期在南亚人群中与心血管疾病的关联似乎比在欧洲人群中弱。这些发现对南亚人群的筛查和早期心血管预防策略具有启示意义。
