Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China.
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.
Diabetes Obes Metab. 2021 Jun;23(6):1361-1370. doi: 10.1111/dom.14348. Epub 2021 Mar 19.
To assess the associations of diabetes duration and glycaemic control (defined by plasma glycated haemoglobin [HbA1c] level) with the risks of cardiovascular disease (CVD) and all-cause mortality and to determine whether the addition of either or both to the established CVD risk factors can improve predictions.
A total of 435 679 participants from the UK Biobank without CVD at baseline were included. Cox models adjusting for classic risk factors (sociodemographic and anthropometric characteristics, lipid profiles and medication use) were used, and predictive utility was determined by the C-index and net reclassification improvement (NRI).
Compared with participants without diabetes, participants with longer diabetes durations and poorer glycaemic control had a higher risk of fatal/nonfatal CVD. Among participants with diabetes, the fully-adjusted hazard ratios (HRs) for diabetes durations of 5 to <10 years, 10 to <15 years and ≥15 years were 1.15 (95% confidence interval [CI] 0.99, 1.34), 1.50 (95% CI 1.26, 1.79) and 2.22 (95% CI 1.90, 2.58; P-trend <0.01), respectively, compared with participants with diabetes durations <5 years. In addition, those with the longest disease duration (≥15 years) and poorer glycaemic control (HbA1c ≥64 mmol/mol [8%]) had the highest risk of fatal/nonfatal CVD (HR 3.12, 95% CI 2.52, 3.86). Among participants with diabetes, the addition of both diabetes duration and glycaemic control levels significantly improved both the C-index (change in C-index +0.0254; 95% CI 0.0111, 0.0398) and the overall NRI for fatal/nonfatal CVD (0.0992; 95% CI 0.0085, 0.1755) beyond the use of the classic risk factors.
Both longer diabetes duration and poorer glycaemic control were associated with elevated risks of CVD and mortality. Clinicians should consider not only glycaemic control but also diabetes duration in CVD risk assessments for participants with diabetes.
评估糖尿病病程和血糖控制（通过血浆糖化血红蛋白[HbA1c]水平定义）与心血管疾病（CVD）和全因死亡率风险的关联，并确定将其中任何一个或两个因素与既定的 CVD 危险因素相结合是否可以改善预测。
共纳入英国生物库 435679 名基线时无 CVD 的参与者。使用调整经典危险因素（社会人口学和人体测量特征、脂质谱和药物使用）的 Cox 模型，并通过 C 指数和净重新分类改善（NRI）确定预测效果。
与无糖尿病的参与者相比，病程较长和血糖控制较差的参与者发生致命/非致命 CVD 的风险更高。在患有糖尿病的参与者中，病程 5 至<10 年、10 至<15 年和≥15 年的全调整危险比（HR）分别为 1.15（95%置信区间 [CI] 0.99，1.34）、1.50（95% CI 1.26，1.79）和 2.22（95% CI 1.90，2.58；P<0.01），与病程<5 年的参与者相比。此外，病程最长（≥15 年）和血糖控制最差（HbA1c≥64mmol/mol[8%]）的患者发生致命/非致命 CVD 的风险最高（HR 3.12，95% CI 2.52，3.86）。在患有糖尿病的参与者中，同时加入糖尿病病程和血糖控制水平可显著提高致命/非致命 CVD 的 C 指数（C 指数变化+0.0254；95% CI 0.0111，0.0398）和整体 NRI（0.0992；95% CI 0.0085，0.1755），优于经典危险因素的使用。
糖尿病病程较长和血糖控制较差均与 CVD 和死亡率风险升高相关。临床医生在评估糖尿病患者的 CVD 风险时，不仅应考虑血糖控制，还应考虑糖尿病病程。
