Khosravi A, Gharipour M, Nezafati P, Khosravi Z, Sadeghi M, Khaledifar A, Taheri M, Golshahi J, Sarrafzadegan N
Department of Cardiology, Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Molecular Epidemiology, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
J Hum Hypertens. 2017 Jun;31(6):382-387. doi: 10.1038/jhh.2016.42. Epub 2016 Jun 23.
The present study aimed to assess the value of pre-diabetes and pre-hypertension in predicting cardiovascular events. A population-based, cross-sectional survey was conducted, representing a large sample of the general Iranian population aged 35 years and older from the Isfahan Province and determined using a random, multistage cluster-sampling 10-year cohort. The five end points considered as study outcome were unstable angina (UA), acute occurrence of myocardial infarction (MI), sudden cardiac death (SCD), brain stroke and cardiovascular disease (CVD). Of the 6323 subjects scheduled for assessment of diabetes state 617 were diabetics and 712 were pre-diabetic. In addition, of these subjects, 1754 had hypertension and 2500 had pre-hypertension. Analysing only pre-hypertension, pre-diabetes and its combination and adjusted for gender and age variables, pre-hypertension and pre-diabetes status together, could only effectively predict occurrence of MI (hazard ratio (HR)=3.21, 95% confidence interval (CI): 1.06-9.76, P=0.04). In the same COX regression models, pre-hypertension status could predict UA and CVD occurrence (HR=2.94, 95% CI: 1.68-5.14, P<0.001 and HR=1.74, 95% CI: 1.23-2.47, P=0.002, respectively). However, pre-diabetes status could not predict any of these events after adjustment for gender and age. Our data provide valuable evidence of the triggering role of pre-hypertension and pre-diabetes together, on appearance and progression of MI even in healthy individuals and the significant predicting value of pre-hypertension on the occurrence of UA and CVD. In this regard, the value of pre-hypertension and pre-diabetes together, and the pre-hypertension state alone, are clearly superior to pre-diabetes state alone in predicting cardiovascular events.
本研究旨在评估糖尿病前期和高血压前期在预测心血管事件方面的价值。我们进行了一项基于人群的横断面调查，该调查代表了来自伊斯法罕省35岁及以上伊朗普通人群的大样本，并采用随机、多阶段整群抽样确定了一个10年队列。被视为研究结果的五个终点是不稳定型心绞痛（UA）、急性心肌梗死（MI）、心源性猝死（SCD）、脑卒中和心血管疾病（CVD）。在计划评估糖尿病状态的6323名受试者中，617名是糖尿病患者，712名是糖尿病前期患者。此外，在这些受试者中，1754名患有高血压，2500名患有高血压前期。仅分析高血压前期、糖尿病前期及其组合，并对性别和年龄变量进行校正后，高血压前期和糖尿病前期状态共同作用时，仅能有效预测MI的发生（风险比（HR）=3.21，95%置信区间（CI）：1.06 - 9.76，P = 0.04）。在相同的COX回归模型中，高血压前期状态可预测UA和CVD的发生（HR分别为2.94，95%CI：1.68 - 5.14，P < 0.001；HR为1.74，95%CI：1.23 - 2.47，P = 0.002）。然而，在校正性别和年龄后，糖尿病前期状态无法预测这些事件中的任何一个。我们的数据提供了有价值的证据，证明高血压前期和糖尿病前期共同作用对MI的出现和进展具有触发作用，即使在健康个体中也是如此，以及高血压前期对UA和CVD发生具有显著的预测价值。在这方面，高血压前期和糖尿病前期共同作用以及仅高血压前期状态在预测心血管事件方面明显优于仅糖尿病前期状态。
