Division of Endocrinology and Metabolism Department of Internal Medicine Seoul St. Mary's Hospital College of Medicine The Catholic University of Korea Seoul Korea.
Department of Medical Informatics College of Medicine The Catholic University of Korea Seoul Korea.
J Am Heart Assoc. 2020 Nov 17;9(22):e017475. doi: 10.1161/JAHA.120.017475. Epub 2020 Nov 6.
Background Variability in blood pressure, glucose concentration, cholesterol concentration, or body weight is associated with a wide range of health outcomes. We hypothesized that high variability in metabolic parameters is associated with an increased risk of emergency hospitalization and mortality. Methods and Results Using a nationally representative database from the Korean National Health Insurance System, 8 049 228 individuals who underwent 3 or more health examinations during 2005 to 2010 were followed up until the end of 2016. Variability in fasting blood glucose and total cholesterol concentrations, systolic blood pressure, and body weight was measured using the variability independent of the mean (VIM). High variability was defined as the highest quartile of variability. Subjects were classified according to the number of high variability parameters. The end points of the study were emergency hospitalization and 30-day mortality. There were 733 387 emergency hospitalizations (9.1%) during a median follow-up of 5.6±1.2 years. For each metabolic parameter, an incrementally higher risk of emergency hospitalization was observed for higher VIM quartile groups than for the lowest quartile group. Compared with the group with low variability for all 4 parameters, the group with high variability for all 4 parameters had a significantly higher risk for emergency hospitalization (hazard ratio [HR], 1.58; 95% CI, 1.54-1.61) and 30-day mortality (HR, 2.44; 95% CI, 1.62-3.69), after adjusting for possible confounding factors. Conclusions High variability in metabolic parameters was associated with increased risk of emergency hospitalization and short-term mortality.
背景
血压、血糖浓度、胆固醇浓度或体重的变异性与广泛的健康结果相关。我们假设代谢参数的高变异性与急诊住院和死亡风险增加相关。
方法和结果
使用韩国国家健康保险系统的全国代表性数据库，对 2005 年至 2010 年期间接受了 3 次或更多次健康检查的 8049228 人进行了随访，随访时间直至 2016 年底。空腹血糖和总胆固醇浓度、收缩压和体重的变异性使用均值独立变异（VIM）来测量。高变异性定义为变异性最高的四分位数。根据高变异性参数的数量对受试者进行分类。研究的终点为急诊住院和 30 天死亡率。在中位数为 5.6±1.2 年的随访期间，发生了 733387 例急诊住院（9.1%）。对于每个代谢参数，随着 VIM 四分位组的升高，急诊住院的风险逐渐增加，高于最低四分位组。与所有 4 个参数的变异性低的组相比，所有 4 个参数的变异性高的组的急诊住院风险显著更高（危险比[HR]，1.58；95%置信区间[CI]，1.54-1.61）和 30 天死亡率（HR，2.44；95%CI，1.62-3.69），在调整了可能的混杂因素后。
结论
代谢参数的高变异性与急诊住院和短期死亡率增加相关。
