动脉僵硬度与糖尿病的关系：一项纵向研究。

Arterial Stiffness Preceding Diabetes: A Longitudinal Study.

机构信息

Graduate School (M.Z., Y.S.), North China University of Science and Technology, Kailuan General Hospital, Tangshan, Hebei Province, China.

Department of Cardiology (M.Z., S.C., Y.S., Q.Z., S.W.), North China University of Science and Technology, Kailuan General Hospital, Tangshan, Hebei Province, China.

出版信息

Circ Res. 2020 Dec 4;127(12):1491-1498. doi: 10.1161/CIRCRESAHA.120.317950. Epub 2020 Sep 28.

DOI:10.1161/CIRCRESAHA.120.317950

PMID:32985370

Abstract

RATIONALE

Previous studies on the relationship between diabetes and arterial stiffness were mostly cross-sectional. A few longitudinal studies focused on one single direction. Whether the association between arterial stiffness and diabetes is bidirectional remains unclear to date.

OBJECTIVE

To explore the temporal relationship between arterial stiffness and fasting blood glucose (FBG) status.

METHODS AND RESULTS

Included were 14 159 participants of the Kailuan study with assessment of brachial-ankle pulse wave velocity (baPWV) from 2010 to 2015, and free of diabetes, cardiovascular and cerebrovascular diseases, and chronic kidney disease at baseline. FBG and baPWV were repeatedly measured at baseline and follow-ups. Cox proportional hazard regression model was used to estimate hazard ratios and 95% confidence intervals (CIs) of incident diabetes across baseline baPWV groups: <1400 cm/s (ref), 1400≤ baPWV <1800 cm/s, and ≥1800 cm/s. Path analysis was used to analyze the possible temporal causal relationship between baPWV and FBG, among 8956 participants with repeated assessment of baPWV and FBG twice in 2010 to 2017. The mean baseline age of the observed population was 48.3±12.0 years. During mean 3.72 years of follow-up, 979 incident diabetes cases were identified. After adjusting for potential confounders, the hazard ratio (95% CI) for risk of diabetes was 1.59 (1.34-1.88) for the borderline arterial stiffness group and 2.11 (1.71-2.61) for the elevated arterial stiffness group, compared with the normal ideal arterial stiffness group. In the path analysis, baseline baPWV was associated with follow-up FBG (the standard regression coefficient was 0.09 [95% CI, 0.05-0.10]). In contrast, the standard regression coefficient of baseline FBG for follow-up baPWV (β=0.00 [95% CI, -0.02 to 0.02]) was not significant.

CONCLUSIONS

Arterial stiffness, as measured by baPWV, was associated with risk of developing diabetes. Arterial stiffness appeared to precede the increase in FBG.

摘要

背景

先前关于糖尿病与动脉僵硬度关系的研究大多为横断面研究，少数纵向研究仅关注单一方向。目前，动脉僵硬度与糖尿病之间的关联是否具有双向性尚不清楚。

目的

探讨动脉僵硬度与空腹血糖（FBG）状态之间的时间关系。

方法和结果

纳入了 14159 名参加开滦研究的参与者，这些参与者在 2010 年至 2015 年期间接受了肱踝脉搏波速度（baPWV）评估，且在基线时无糖尿病、心血管和脑血管疾病以及慢性肾脏病。在基线和随访时重复测量 FBG 和 baPWV。使用 Cox 比例风险回归模型估计了基线 baPWV 组中不同血糖状态下的糖尿病发病风险比（HR）和 95%置信区间（CI）：<1400cm/s（参照组）、1400≤baPWV<1800cm/s 和≥1800cm/s。对 8956 名参与者进行了 2010 年至 2017 年两次 baPWV 和 FBG 重复评估，应用路径分析来分析 baPWV 和 FBG 之间可能存在的时间因果关系。观察人群的平均基线年龄为 48.3±12.0 岁。在平均 3.72 年的随访期间，共发现 979 例新发糖尿病病例。在调整了潜在混杂因素后，边界动脉僵硬度组的糖尿病发病风险 HR（95%CI）为 1.59（1.34-1.88），升高的动脉僵硬度组为 2.11（1.71-2.61），与正常理想动脉僵硬度组相比。在路径分析中，基线 baPWV 与随访 FBG 相关（标准回归系数为 0.09[95%CI，0.05-0.10]）。相反，基线 FBG 对随访 baPWV 的标准回归系数（β=0.00[95%CI，-0.02 至 0.02]）不显著。