Wake Forest University School of Medicine, Winston-Salem, NC
Northwestern University, Chicago, IL.
Diabetes Care. 2019 Mar;42(3):457-465. doi: 10.2337/dc18-1773. Epub 2019 Jan 7.
To estimate the long-term absolute risk for cardiovascular disease (CVD) according to fasting glucose (FG) levels below the threshold of diabetes.
We pooled data from seven observational cohorts of U.S. black and white men and women followed from 1960 to 2015. We categorized FG as follows: <5.0, 5.0-5.5, 5.6-6.2, 6.3-6.9 mmol/L, and diabetes (FG ≥7.0 mmol/L or use of diabetes medications). CVD was defined as fatal/nonfatal coronary heart disease and fatal/nonfatal stroke. We estimated the risk of CVD by FG category at index age 55 years using a modified Kaplan-Meier survival analysis, adjusted for the competing risk of non-CVD death. We also assessed risk for incident CVD according to change in FG before 50 years of age, specifically among the categories <5.6 mmol/L, 5.6-6.9 mmol/L, and diabetes.
Our sample included 19,630 individuals (6,197 blacks and 11,015 women) without a prior CVD event. Risk for CVD through 85 years of age ranged from 15.3% (<5.0 mmol/L) to 38.6% (diabetes levels) among women and from 21.5% (5.0-5.5 mmol/L) to 47.7% (diabetes levels) among men. An FG of 6.3-6.9 mmol/L was associated with higher long-term CVD risk compared with the lowest FG among men but not women. Increases in glucose during midlife with conversion to diabetes were associated with higher cardiovascular risk (1.3- to 3.6-fold) than increases in glucose below the diabetes threshold.
Middle-age individuals with diabetes have high long-term absolute risk for CVD. These data strongly support the importance of blood glucose monitoring in midlife for CVD prevention.
根据低于糖尿病阈值的空腹血糖（FG）水平，估计心血管疾病（CVD）的长期绝对风险。
我们汇总了美国黑人和白人男性和女性从 1960 年到 2015 年期间随访的七个观察性队列的数据。我们将 FG 分为以下几类：<5.0、5.0-5.5、5.6-6.2、6.3-6.9 mmol/L 和糖尿病（FG≥7.0 mmol/L 或使用糖尿病药物）。CVD 定义为致死性/非致死性冠心病和致死性/非致死性中风。我们使用改良的 Kaplan-Meier 生存分析，根据非 CVD 死亡的竞争风险，在指数年龄 55 岁时按 FG 类别估计 CVD 的风险。我们还根据 50 岁之前 FG 的变化评估了 CVD 发病风险，特别是在<5.6 mmol/L、5.6-6.9 mmol/L 和糖尿病类别中。
我们的样本包括 19630 名（6197 名黑人，11015 名女性）没有先前 CVD 事件的个体。在女性中，85 岁以下 CVD 风险范围从 15.3%（<5.0 mmol/L）到 38.6%（糖尿病水平），在男性中从 21.5%（5.0-5.5 mmol/L）到 47.7%（糖尿病水平）。与男性最低 FG 相比，6.3-6.9 mmol/L 的 FG 与更高的长期 CVD 风险相关，但在女性中并非如此。中年时血糖升高并转为糖尿病与心血管风险升高（1.3 至 3.6 倍）相关，高于糖尿病阈值以下的血糖升高。
患有糖尿病的中年个体 CVD 的长期绝对风险较高。这些数据强烈支持在中年期间进行血糖监测以预防 CVD 的重要性。
