Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong.
Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong
J Am Heart Assoc. 2017 Aug 17;6(8):e006400. doi: 10.1161/JAHA.117.006400.
The relative effect of hemoglobin A1c, blood pressure, and low-density lipoprotein-cholesterol (LDL-C) ("ABC" factors) on the prevention of cardiovascular diseases (CVD) among patients with type 2 diabetes mellitus is poorly understood. This study aimed to evaluate the association of key clinical parameters on CVD risk using a multifactorial optimal control approach in Chinese primary care patients with type 2 diabetes mellitus.
A population-based retrospective cohort study was conducted on 144 271 Chinese type 2 diabetes mellitus primary care patients, aged 18 to 79 and without prior clinical diagnosis of CVD in 2008-2011. Cox regressions were conducted to examine the association between the combinations of ABC targets (hemoglobin A1c <7%, blood pressure <130/90 mm Hg, and LDL-C <2.6 mmol/L) and risks of CVD (overall), coronary heart disease, stroke, and heart failure. Achieving more ABC targets incrementally reduced the incidence of total CVD and individual disease including coronary heart disease, stroke, and heart failure, irrespective of other patient characteristics. Compared with suboptimal control in all ABC levels, achieving any 1, 2, and all 3 ABC targets reduced the relative risk of CVD by 13% to 42%, 31% to 52%, and 55%, respectively. Among those achieving only 1 ABC target, LDL-C reduction was associated with the greatest CVD risk reduction (42%), followed by blood pressure reduction (18%), and hemoglobin A1c reduction (13%).
To achieve the greatest risk reduction for the incidence of CVD, the ultimate goal of treatment should be to achieve target control of hemoglobin A1c, blood pressure, and LDL-C. If it is not possible to achieve all 3 targets, efforts should be prioritized on treating the LDL-C to minimize CVD risk.
糖化血红蛋白（HbA1c）、血压和低密度脂蛋白胆固醇（LDL-C）（“ABC”因素）对 2 型糖尿病患者心血管疾病（CVD）预防的相对作用仍不清楚。本研究旨在通过多因素最佳控制方法评估中国 2 型糖尿病基层医疗患者中关键临床参数对 CVD 风险的相关性。
对 2008-2011 年期间年龄 18-79 岁且无 CVD 既往临床诊断的 144271 例中国 2 型糖尿病基层医疗患者进行了一项基于人群的回顾性队列研究。采用 Cox 回归分析评估了 HbA1c<7%、血压<130/90mmHg 和 LDL-C<2.6mmol/L 这 3 个 ABC 目标的组合与 CVD（整体）、冠心病、卒中和心力衰竭风险之间的关系。逐渐实现更多的 ABC 目标可降低总 CVD 及包括冠心病、卒中和心力衰竭在内的各疾病的发病风险，无论其他患者特征如何。与所有 ABC 水平的次优控制相比，实现任何 1、2 和 3 个 ABC 目标可使 CVD 的相对风险分别降低 13%至 42%、31%至 52%和 55%。在仅实现 1 个 ABC 目标的患者中，LDL-C 降低与 CVD 风险降低相关性最大（42%），其次是血压降低（18%）和 HbA1c 降低（13%）。
为了使 CVD 发病风险降低最大，治疗的最终目标应该是实现 HbA1c、血压和 LDL-C 的目标控制。如果不可能实现 3 个目标，则应优先努力降低 LDL-C 以最小化 CVD 风险。
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