Department of Scientific Research and Education, Shunde Hospital, Southern Medical University, Foshan, China.
Key Laboratory of Neuroscience, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou, China.
BMJ. 2020 Jul 15;370:m2297. doi: 10.1136/bmj.m2297.
To evaluate the associations between prediabetes and the risk of all cause mortality and incident cardiovascular disease in the general population and in patients with a history of atherosclerotic cardiovascular disease.
Updated meta-analysis.
Electronic databases (PubMed, Embase, and Google Scholar) up to 25 April 2020.
Prospective cohort studies or post hoc analysis of clinical trials were included for analysis if they reported adjusted relative risks, odds ratios, or hazard ratios of all cause mortality or cardiovascular disease for prediabetes compared with normoglycaemia. Data were extracted independently by two investigators. Random effects models were used to calculate the relative risks and 95% confidence intervals. The primary outcomes were all cause mortality and composite cardiovascular disease. The secondary outcomes were the risk of coronary heart disease and stroke.
A total of 129 studies were included, involving 10 069 955 individuals for analysis. In the general population, prediabetes was associated with an increased risk of all cause mortality (relative risk 1.13, 95% confidence interval 1.10 to 1.17), composite cardiovascular disease (1.15, 1.11 to 1.18), coronary heart disease (1.16, 1.11 to 1.21), and stroke (1.14, 1.08 to 1.20) in a median follow-up time of 9.8 years. Compared with normoglycaemia, the absolute risk difference in prediabetes for all cause mortality, composite cardiovascular disease, coronary heart disease, and stroke was 7.36 (95% confidence interval 9.59 to 12.51), 8.75 (6.41 to 10.49), 6.59 (4.53 to 8.65), and 3.68 (2.10 to 5.26) per 10 000 person years, respectively. Impaired glucose tolerance carried a higher risk of all cause mortality, coronary heart disease, and stroke than impaired fasting glucose. In patients with atherosclerotic cardiovascular disease, prediabetes was associated with an increased risk of all cause mortality (relative risk 1.36, 95% confidence interval 1.21 to 1.54), composite cardiovascular disease (1.37, 1.23 to 1.53), and coronary heart disease (1.15, 1.02 to 1.29) in a median follow-up time of 3.2 years, but no difference was seen for the risk of stroke (1.05, 0.81 to 1.36). Compared with normoglycaemia, in patients with atherosclerotic cardiovascular disease, the absolute risk difference in prediabetes for all cause mortality, composite cardiovascular disease, coronary heart disease, and stroke was 66.19 (95% confidence interval 38.60 to 99.25), 189.77 (117.97 to 271.84), 40.62 (5.42 to 78.53), and 8.54 (32.43 to 61.45) per 10 000 person years, respectively. No significant heterogeneity was found for the risk of all outcomes seen for the different definitions of prediabetes in patients with atherosclerotic cardiovascular disease (all P>0.10).
Results indicated that prediabetes was associated with an increased risk of all cause mortality and cardiovascular disease in the general population and in patients with atherosclerotic cardiovascular disease. Screening and appropriate management of prediabetes might contribute to primary and secondary prevention of cardiovascular disease.
评估在一般人群和有动脉粥样硬化性心血管疾病史的患者中，前驱糖尿病与全因死亡率和心血管疾病事件的风险之间的关联。
更新的荟萃分析。
电子数据库（PubMed、Embase 和 Google Scholar），截至 2020 年 4 月 25 日。
如果前瞻性队列研究或临床试验的事后分析报告了与正常血糖相比，前驱糖尿病的全因死亡率或心血管疾病的调整相对风险、比值比或风险比，则纳入分析。两名研究者独立提取数据。使用随机效应模型计算相对风险和 95%置信区间。主要结局为全因死亡率和复合心血管疾病。次要结局为冠心病和卒中的风险。
共纳入 129 项研究，涉及 10069955 人进行分析。在一般人群中，前驱糖尿病与全因死亡率（相对风险 1.13，95%置信区间 1.10 至 1.17）、复合心血管疾病（1.15，1.11 至 1.18）、冠心病（1.16，1.11 至 1.21）和卒中（1.14，1.08 至 1.20）的风险增加相关，中位随访时间为 9.8 年。与正常血糖相比，前驱糖尿病患者的全因死亡率、复合心血管疾病、冠心病和卒中的绝对风险差异分别为 7.36（95%置信区间 9.59 至 12.51）、8.75（6.41 至 10.49）、6.59（4.53 至 8.65）和 3.68（2.10 至 5.26）/10000 人年。与空腹血糖受损相比，葡萄糖耐量受损与全因死亡率、冠心病和卒中的风险升高有关。在有动脉粥样硬化性心血管疾病的患者中，前驱糖尿病与全因死亡率（相对风险 1.36，95%置信区间 1.21 至 1.54）、复合心血管疾病（1.37，1.23 至 1.53）和冠心病（1.15，1.02 至 1.29）的风险增加相关，中位随访时间为 3.2 年，但卒中风险无差异（1.05，0.81 至 1.36）。与正常血糖相比，在有动脉粥样硬化性心血管疾病的患者中，前驱糖尿病患者的全因死亡率、复合心血管疾病、冠心病和卒中的绝对风险差异分别为 66.19（95%置信区间 38.60 至 99.25）、189.77（117.97 至 271.84）、40.62（5.42 至 78.53）和 8.54（32.43 至 61.45）/10000 人年。在有动脉粥样硬化性心血管疾病的患者中，不同定义的前驱糖尿病的各种结局的风险未见显著异质性（所有 P>0.10）。
结果表明，前驱糖尿病与一般人群和有动脉粥样硬化性心血管疾病患者的全因死亡率和心血管疾病风险增加相关。筛查和适当管理前驱糖尿病可能有助于心血管疾病的一级和二级预防。
