Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA 15260, United States.
Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA 15260, United States.
Diabetes Res Clin Pract. 2020 May;163:108141. doi: 10.1016/j.diabres.2020.108141. Epub 2020 Apr 8.
We compared risk factors for three CVD manifestations and a composite outcome over 25 years' follow-up in the Pittsburgh Epidemiology of Diabetes Complications (EDC) prospective cohort study of childhood-onset (<17 years) type 1 diabetes (n = 658).
First CVD manifestations examined were: (1) major atherosclerotic cardiovascular event (MACE, i.e. CVD death, myocardial infarction, stroke), (2) coronary revascularization, (3) soft coronary artery disease (CAD, i.e. ischemia ECG, angina), and a (4) composite (MACE + revascularization) outcome. Baseline and time-varying mean and current risk factors, including medication use, were assessed, in diabetes duration-adjusted models.
MACE (n = 107) was predicted by ln(albumin excretion rate) (AER, HR = 1.3, p < 0.0001), systolic BP (SBP, HR = 1.03, p < 0.0001), white blood cell count (WBC, HR = 1.2, p < 0.0001), HbA1c (HR = 1.2p = 0.03), LDLc (HR = 1.01, p = 0.03). Soft CAD (n = 91) was predicted by ln(AER) (HR = 1.2, p = 0.004), SBP (HR = 1.03, p = 0.0002), WBC (HR = 1.2, p = 0.0003), HbA1c (HR = 1.2, p = 0.005). Revascularization (n = 38) was predicted by LDLc (HR = 1.03, p < 0.0001), eGFR (HR = 0.98, p = 0.002), HbA1c (HR = 1.3, p = 0.03). Adding revascularization to MACE enhanced the role of LDLc, while diminishing that of HbA1c, compared to MACE alone.
Important risk factor associations may be affected by examining composite CVD outcomes. More research is needed to determine how to best incorporate revascularization into composite CVD definitions.
我们比较了 658 名儿童期（<17 岁） 1 型糖尿病患者（Pittsburgh 糖尿病并发症流行病学 [EDC] 前瞻性队列研究）在 25 年随访期间三种心血管疾病（CVD）表现和复合结局的风险因素。
首先检查的 CVD 表现是：（1）主要动脉粥样硬化性心血管事件（MACE，即 CVD 死亡、心肌梗死、中风），（2）冠状动脉血运重建，（3）软冠状动脉疾病（CAD，即缺血性心电图、心绞痛），和（4）复合（MACE+血运重建）结局。在糖尿病病程调整模型中，评估基线和时变的平均和当前风险因素，包括药物使用情况。
MACE（n=107）由 ln（白蛋白排泄率）（AER，HR=1.3，p<0.0001）、收缩压（SBP，HR=1.03，p<0.0001）、白细胞计数（WBC，HR=1.2，p<0.0001）、HbA1c（HR=1.2，p=0.03）和 LDLc（HR=1.01，p=0.03）预测。软 CAD（n=91）由 ln（AER）（HR=1.2，p=0.004）、SBP（HR=1.03，p=0.0002）、WBC（HR=1.2，p=0.0003）和 HbA1c（HR=1.2，p=0.005）预测。血运重建（n=38）由 LDLc（HR=1.03，p<0.0001）、eGFR（HR=0.98，p=0.002）和 HbA1c（HR=1.3，p=0.03）预测。与仅 MACE 相比，将血运重建加入 MACE 可增强 LDLc 的作用，同时降低 HbA1c 的作用。
检查复合 CVD 结局可能会影响重要的风险因素关联。需要进一步研究如何将血运重建最佳纳入复合 CVD 定义。
