Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy.
Diabetes Trials Unit, OCDEM, University of Oxford, Oxford, UK.
Diabetes Obes Metab. 2019 Sep;21(9):2115-2122. doi: 10.1111/dom.13788. Epub 2019 Jun 19.
Latent autoimmune diabetes in adults (LADA) is diagnosed in up to 12% of adults with clinically diagnosed type 2 diabetes (T2D). LADA tends to have healthier cardiovascular (CV) risk profiles than T2D, but it remains uncertain whether the risk of CV events differs between the two. We examined the risk of CV events in patients enrolled in the United Kingdom Prospective Diabetes Study (UKPDS) according to LADA status.
Diabetes autoantibodies (AAb) were measured in 5062 UKPDS participants. The incidence of major adverse CV events (MACE), defined as CV death, non-fatal myocardial infarction or non-fatal stroke, was compared in those with LADA (≥1 AAb test positive) and those without LADA (AAb negative).
There were 567 participants (11.2%) with LADA. Compared with participants with T2D, they were younger, with higher mean HbA1c and HDL-cholesterol values, and with lower body mass index and total cholesterol and systolic blood pressure values (all P < 0.01). After a median (25th, 75th percentile) 17.3 (12.6-20.7) years of follow-up, MACE occurred in 157 (17.4 per 1000 person-years) participants with LADA and in 1544 (23.5 per 1000 person-years) participants with T2D (HR, 0.73; 95% confidence interval [CI], 0.62-0.86; P < 0.001). However, after adjustment for confounders, this difference was no longer significant (HR , 0.90; 95% CI, 0.76-1.07; P = 0.22).
In adults thought to have newly diagnosed T2D, the long-term risk of MACE was lower in those with LADA. However, this did not differ after adjustment for traditional CV risk factors, suggesting that measurement of AAb in addition to traditional CV risk factors will not aid in stratification of CV risk in clinically diagnosed T2D.
成年人隐匿性自身免疫糖尿病（LADA）在临床上被诊断为 2 型糖尿病（T2D）的成年人中占比高达 12%。与 T2D 相比，LADA 患者的心血管（CV）风险状况往往更为健康，但目前尚不确定这两种疾病的 CV 事件风险是否存在差异。我们通过检测英国前瞻性糖尿病研究（UKPDS）中入组患者的 LADA 状态，来评估其 CV 事件风险。
在 UKPDS 的 5062 名参与者中测量了糖尿病自身抗体（AAb）。比较 LADA（≥1 项 AAb 检测阳性）患者和无 LADA（AAb 阴性）患者的主要不良 CV 事件（MACE）发生率，MACE 定义为 CV 死亡、非致死性心肌梗死或非致死性卒中。
共有 567 名（11.2%）参与者患有 LADA。与 T2D 患者相比，LADA 患者年龄更小，平均 HbA1c 和高密度脂蛋白胆固醇水平更高，而体重指数、总胆固醇和收缩压水平更低（均 P<0.01）。中位（25 分位，75 分位）随访 17.3（12.6-20.7）年后，LADA 患者中有 157 人（17.4/1000 人年）和 T2D 患者中有 1544 人（23.5/1000 人年）发生 MACE（HR，0.73；95%CI，0.62-0.86；P<0.001）。然而，在校正混杂因素后，这种差异不再显著（HR，0.90；95%CI，0.76-1.07；P=0.22）。
在新诊断为 T2D 的成年人中，LADA 患者的 MACE 长期风险较低。然而，在校正传统 CV 危险因素后，这种差异并不明显，这表明在临床上诊断为 T2D 的患者中，除了传统 CV 危险因素外，检测 AAb 并不能帮助分层 CV 风险。
