Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine.
Osaka Center for Cancer and Cardiovascular Disease Prevention.
Circ J. 2018 May 25;82(6):1598-1604. doi: 10.1253/circj.CJ-17-0950. Epub 2018 Feb 14.
The effect of postprandial glucose on the risk of cardiovascular disease has been emphasized, but it is controversial whether nonfasting glucose is related to incident stroke and its types.
We investigated the associations of nonfasting glucose with incident stroke and its types among 7,198 participants aged 40-74 years from the Circulatory Risk in Communities Study, enrolled in 1995-2000. We estimated multivariable hazard ratios (HR) using Cox proportional hazard models. Over a median follow-up of 14.1 years, 291 cases of total stroke (ischemic strokes: 191 including 109 lacunar infarctions) were identified. Nonfasting glucose concentration was associated with greater risk of incident total stroke, ischemic stroke and lacunar infarction when modeled categorically (for prediabetic type: 7.8-11.0 mmol/L vs. normal type: <7.8 mmol/L among all subjects, HR for lacunar infarction was 2.02, 95% confidence interval (CI): 1.19, 3.43) or continuously (per one standard deviation increment among all subjects, HR for lacunar infarction was 1.29, 95% CI: 1.15, 1.45). Diabetic type showed similar results. Population attributable fractions of nonfasting hyperglycemia were 13.2% for ischemic stroke and 17.4% for lacunar infarction.
Nonfasting glucose concentration, either as a diagnosis of prediabetic and diabetic types or as a continuous variable, proved to be an independent predictor significantly attributed to incident total stroke, especially ischemic stroke and lacunar infarction, in the general population.
餐后血糖对心血管疾病风险的影响已得到强调，但非空腹血糖是否与卒中事件及其类型相关仍存在争议。
我们在 1995-2000 年期间纳入了来自社区循环风险研究（Circulatory Risk in Communities Study）的 7198 名年龄在 40-74 岁的参与者，调查了非空腹血糖与卒中事件及其类型之间的关系。我们使用 Cox 比例风险模型估计多变量风险比（HR）。在中位数为 14.1 年的随访期间，共确定了 291 例总卒中（缺血性卒中：191 例，其中包括 109 例腔隙性梗死）。当以分类（糖尿病前期类型：7.8-11.0mmol/L 与正常类型：<7.8mmol/L 相比）或连续（所有受试者中每增加一个标准差，腔隙性梗死的 HR 为 1.29，95%置信区间[CI]：1.15，1.45）建模时，非空腹血糖浓度与总卒中、缺血性卒中和腔隙性梗死的发病风险增加相关。糖尿病类型也显示出类似的结果。非空腹高血糖的人群归因分数（population attributable fraction）为缺血性卒中和腔隙性梗死的 13.2%和 17.4%。
非空腹血糖浓度，无论是作为糖尿病前期和糖尿病类型的诊断，还是作为一个连续变量，都证明是非空腹血糖浓度是一般人群总卒中，特别是缺血性卒中和腔隙性梗死的独立预测因素。
