Peng Xuenan, Ge Jinzhuo, Wang Congju, Sun Hongpeng, Ma Qinghua, Xu Yong, Ma Yana
Medical College of Soochow University, Suzhou 215123, China.
Department of Child Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Soochow University, Suzhou 215123, China.
Int J Hypertens. 2020 Apr 21;2020:8953058. doi: 10.1155/2020/8953058. eCollection 2020.
Diabetes is a known independent risk factor for stroke. However, whether higher glucose levels (126-139.9 mg/dl) can increase the risk of stroke in people without diabetes is still unknown. Moreover, as a fluctuating parameter, long-term glucose levels may also be related to the risk of stroke outcome. It is important to explore the correlation between long-term average blood glucose, as well as its variability, and stroke.
We used 40,975 clinical measurements of glucose levels and 367 measurements of glycated hemoglobin A1c levels from 12,321 participants without stroke to examine the relationship between glucose levels and the risk of stroke. Participants were from the Weitang Geriatric Diseases study, including 5,707 men and 6,614 women whose mean age at baseline was 60.8 years; 1,011 participants had diabetes, and 11,310 did not. We estimated the long-term average blood glucose level based on the multilevel Bayesian model and fit in Cox regression models, stratified according to diabetes status.
Over a median follow-up period of 5 years, stroke developed in 279 of the 12,321 participants (244 without diabetes and 35 with). For people with an average glucose level of 126-139.9 mg per deciliter, compared with 90-99.9 mg per deciliter, the adjusted hazard ratio (HR) for total stroke was 1.78 (95% confidence interval (CI), 1.16-2.75), and the HR for levels higher than 140 mg per deciliter was 1.89 (95% CI, 1.09-3.29). Among those without diabetes whose glucose level was higher than 140 mg per deciliter, compared with 90-99.9 mg per deciliter, the adjusted HRs for total stroke and fatal stroke were 3.66 (95% CI, 1.47-9.08) and 5 (95% CI, 1.77-14.15), respectively. For a glucose standard deviation level higher than 13.83 mg per deciliter, compared with that lower than 5.91 mg per deciliter, the adjusted HR for total stroke was 2.31 (95% CI, 1.19-4.48).
Our results suggest that higher average glucose levels (126-139.9 mg/dl) and variance may be risk factors for stroke, even among people without diabetes diagnosis.
糖尿病是已知的中风独立危险因素。然而，血糖水平较高（126 - 139.9毫克/分升）是否会增加非糖尿病患者中风的风险仍不清楚。此外，作为一个波动参数，长期血糖水平也可能与中风结局风险相关。探索长期平均血糖及其变异性与中风之间的相关性很重要。
我们使用了来自12321名无中风参与者的40975次血糖水平临床测量值和367次糖化血红蛋白A1c水平测量值，以研究血糖水平与中风风险之间的关系。参与者来自渭塘老年病研究，包括5707名男性和6614名女性，基线平均年龄为60.8岁；1011名参与者患有糖尿病，11310名没有。我们基于多水平贝叶斯模型估计长期平均血糖水平，并拟合Cox回归模型，根据糖尿病状态进行分层。
在中位随访期5年期间，12321名参与者中有279人发生中风（244人无糖尿病且有35人有糖尿病）。对于平均血糖水平为126 - 139.9毫克/分升的人群，与90 - 99.9毫克/分升相比，总中风的调整后风险比（HR）为1.78（95%置信区间（CI），1.16 - 2.75），高于每分升140毫克水平的HR为1.89（95% CI，1.09 - 3.29）。在血糖水平高于每分升140毫克的非糖尿病患者中，与90 - 99.9毫克/分升相比，总中风和致命性中风的调整后HR分别为3.66（95% CI，1.47 - 9.08）和5（95% CI，1.77 - 14.15）。对于血糖标准差水平高于13.83毫克/分升的情况，与低于5.91毫克/分升相比，总中风的调整后HR为2.31（95% CI，1.19 - 4.48）。
我们的结果表明，较高的平均血糖水平（126 - 139.9毫克/分升）和变异性可能是中风的危险因素，即使在未诊断为糖尿病的人群中也是如此。
