Eastwood Sophie V, Tillin Therese, Sattar Naveed, Forouhi Nita G, Hughes Alun D, Chaturvedi Nish
Institute of Cardiovascular Science, University College London, London, U.K.
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K.
Diabetes Care. 2015 Dec;38(12):2325-32. doi: 10.2337/dc15-1078. Epub 2015 Oct 20.
We examined longitudinal associations between prediabetes and cardiovascular disease (CVD) (coronary heart disease [CHD] and stroke) in Europeans and South Asians.
This was a U.K. cohort study of 1,336 Europeans and 1,139 South Asians, aged 40-69 years at baseline (1988-1991). Assessment included blood pressure, blood tests, anthropometry, and questionnaires. Prediabetes was determined by OGTT or HbA1c, using either International Expert Committee (IEC) (HbA1c 6.0-6.5% [42-48 mmol/mol]) or American Diabetes Association (ADA) (HbA1c 5.7-6.5% [39-48 mmol/mol]) cut points. Incident CHD and stroke were established at 20 years from death certification, hospital admission, primary care record review, and participant report.
Compared with normoglycemic individuals, IEC-defined prediabetes was related to both CHD and CVD risk in Europeans but not South Asians (subhazard ratio for CHD 1.68 [95% CI 1.19, 2.38] vs. 1.00 [0.75, 1.33], ethnicity interaction P = 0.008, and for CVD 1.49 [1.08, 2.07] vs. 1.03 [0.78, 1.36], ethnicity interaction P = 0.04). Conversely, IEC-defined prediabetes was associated with stroke risk in South Asians but not Europeans (1.73 [1.03, 2.90] vs. 0.85 [0.44, 1.64], ethnicity interaction P = 0.11). Risks were adjusted for age, sex, smoking, total-to-HDL cholesterol ratio, waist-to-hip ratio, systolic blood pressure, and antihypertensive use. Associations were weaker for OGTT or ADA-defined prediabetes. Conversion from prediabetes to diabetes was greater in South Asians, but accounting for time to conversion did not account for these ethnic differences.
Associations between prediabetes and CVD differed by prediabetes diagnostic criterion, type of CVD, and ethnicity, with associations being present for overall CVD in Europeans but not South Asians. Substantiation of these findings and investigation of potential explanations are required.
我们研究了欧洲人和南亚人中糖尿病前期与心血管疾病（CVD）（冠心病[CHD]和中风）之间的纵向关联。
这是一项针对1336名欧洲人和1139名南亚人的英国队列研究，基线时（1988 - 1991年）年龄在40 - 69岁。评估包括血压、血液检测、人体测量学和问卷调查。糖尿病前期通过口服葡萄糖耐量试验（OGTT）或糖化血红蛋白（HbA1c）来确定，采用国际专家委员会（IEC）（HbA1c 6.0 - 6.5%[42 - 48 mmol/mol]）或美国糖尿病协会（ADA）（HbA1c 5.7 - 6.5%[39 - 48 mmol/mol]）的切点。根据死亡证明、住院记录、初级医疗记录审查和参与者报告，在20年后确定CHD和中风的发病情况。
与血糖正常的个体相比，IEC定义的糖尿病前期与欧洲人的CHD和CVD风险均相关，但与南亚人无关（CHD的亚风险比为1.68[95%可信区间1.19, 2.38]，而南亚人为1.00[0.75, 1.33]，种族交互作用P = 0.008；CVD的亚风险比为1.49[1.08, 2.07]，而南亚人为1.03[0.78, 1.36]，种族交互作用P = 0.04）。相反，IEC定义的糖尿病前期与南亚人的中风风险相关，但与欧洲人无关（1.73[1.03, 2.90]，而欧洲人为0.85[0.44, 1.64]，种族交互作用P = 0.11）。对年龄、性别、吸烟、总胆固醇与高密度脂蛋白胆固醇比值、腰臀比、收缩压和抗高血压药物使用情况进行了风险调整。OGTT或ADA定义的糖尿病前期的关联较弱。南亚人从糖尿病前期转变为糖尿病的比例更高，但考虑转变时间并不能解释这些种族差异。
糖尿病前期与CVD之间的关联因糖尿病前期诊断标准、CVD类型和种族而异，欧洲人总体CVD存在关联，而南亚人则不存在。需要对这些发现进行证实并调查潜在的解释。
