Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China.
Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China.
J Am Heart Assoc. 2018 Feb 13;7(4):e007607. doi: 10.1161/JAHA.117.007607.
Fasting plasma glucose (FPG) levels can vary over time and its longitudinal changing patterns may predict cardiometabolic risk. We aim to identify different trajectories of FPG in those who remained normoglycemic and investigate the association between trajectory groups and coronary heart disease risk in a large prospective cohort study.
A total of 20 514 subjects between ages 20 and 80 years were included at baseline. All participants had maintained normal FPG throughout an average follow-up period of 5.8 years. We identified 3 distinct trajectories using a group-based trajectory model, labeled by initial value and changing pattern: low-increasing (n=12 694), high-increasing-decreasing (n=5330), and high-decreasing-increasing (n=2490). The coronary heart disease incidence density among these 3 groups (3.00, 4.05, and 3.26 per 1000 person-years, respectively) was significantly different (=0.038). The high-increasing-decreasing group was characterized by a starting FPG of 4.80 mmol/L, and increased up to 5.42 mmol/L at age 55, then decreased thereafter. Treating the low-increasing group as the reference, the age- and sex-adjusted hazard ratio was 1.58 (95% confidence interval, 1.23-2.02) for the high-increasing-decreasing group by Cox proportional hazard regression. After adjustment for other potential confounding factors, the hazard ratio is 1.40 (95% confidence interval, 1.08-1.81). The association persisted after adjustment for baseline FPG, mean, or SD of FPG.
Distinct trajectories of long-term normal FPG are associated with the development of coronary heart disease, which is independent of other metabolic factors including FPG levels. These findings have implications for intervention and prevention of coronary heart disease among individuals who are normoglycemic.
空腹血糖（FPG）水平随时间而变化，其纵向变化模式可能预测心血管代谢风险。我们旨在确定在血糖正常的人群中 FPG 的不同轨迹，并在一项大型前瞻性队列研究中调查轨迹组与冠心病风险之间的关系。
共纳入 20514 名年龄在 20 至 80 岁之间的受试者。所有参与者在平均 5.8 年的随访期间均保持正常 FPG。我们使用基于群组的轨迹模型确定了 3 个不同的轨迹，根据初始值和变化模式标记为：低升高型（n=12694）、高升高-降低型（n=5330）和高降低-升高型（n=2490）。这 3 组的冠心病发生率密度（分别为 3.00、4.05 和 3.26/1000 人年）显著不同（=0.038）。高升高-降低组的初始 FPG 为 4.80mmol/L，在 55 岁时升高至 5.42mmol/L，此后下降。通过 Cox 比例风险回归，将低升高组作为参考，高升高-降低组的年龄和性别调整后的危险比为 1.58（95%置信区间，1.23-2.02）。在调整其他潜在混杂因素后，危险比为 1.40（95%置信区间，1.08-1.81）。该关联在调整基线 FPG、FPG 的均值或标准差后仍然存在。
长期正常 FPG 的不同轨迹与冠心病的发生有关，这与包括 FPG 水平在内的其他代谢因素无关。这些发现对血糖正常人群的冠心病干预和预防具有重要意义。
