Center for Life Course Health Research, University of Oulu, Oulu, Finland.
Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
Ann Med. 2021 Dec;53(1):478-484. doi: 10.1080/07853890.2021.1902557.
To estimate the ability of fasting, 1-h, and 2-h post-load glucose to predict cardiovascular outcomes.
We examined a population-based study consisting of 977 middle-aged subjects who underwent an oral glucose tolerance test with glucose values measured at 0, 60, and 120 min. Participants were followed up to 24 years, and cardiovascular outcomes were collected from national registers. Predictive abilities of fasting, 1-h, and 2-h glucose were evaluated alone and in the prediction models with traditional cardiovascular risk factors using Cox proportional hazard models, the likelihood-ratio test, Harrell's concordance index and integrated discrimination improvement.
Cardiovascular endpoint occurred in 222 (22.7%) participants during a median follow-up of 19.8 years. In the prognostic models, 1-h glucose (HR 1.67, 95%CI 1.10-2.53), but not fasting or 2-h glucose, predicted cardiovascular events statistically significantly. In addition, when adding glucose parameters into the model including traditional cardiovascular risk factors, only 1-h glucose improved the predictive ability (LR-test =.046). Finally, 1-h glucose found slightly over 50% more cardiovascular endpoints that were not recognized by fasting or 2-h glucose levels.
Our findings support the earlier ones suggesting that 1-h glucose would be a better long-term predictor of cardiovascular morbidity and mortality than fasting or 2-h glucose.KEY MESSAGESIn addition to conventional CV risk factors,1-h but not fasting or 2-h post-load glucoses seems to be an independent predictor of cardiovascular events and seems to improve the predictive ability of the traditional cardiovascular risk model.Elevated 1-hpost-load glucose finds a large number (slightly over 50%)of cardiovascular endpoints that were not recognized by fasting or 2-h post-load glucose levels.One-hour glucose seems to be a better long-term predictor of cardiovascular morbidity and mortality than fasting or 2-h post-load glucose.
评估空腹、1 小时和 2 小时负荷后血糖预测心血管结局的能力。
我们研究了一项基于人群的研究，该研究纳入了 977 名中年受试者，他们接受了口服葡萄糖耐量试验，血糖值在 0、60 和 120 分钟时进行测量。参与者随访 24 年，心血管结局从国家登记处收集。使用 Cox 比例风险模型、似然比检验、Harrell 一致性指数和综合判别改善来评估空腹、1 小时和 2 小时血糖的单独预测能力和在包含传统心血管危险因素的预测模型中的预测能力。
在中位随访 19.8 年期间，222 名（22.7%）参与者发生心血管终点事件。在预后模型中，1 小时血糖（HR 1.67，95%CI 1.10-2.53），而不是空腹或 2 小时血糖，具有统计学意义地预测了心血管事件。此外，当将血糖参数添加到包含传统心血管危险因素的模型中时，只有 1 小时血糖改善了预测能力（LR 检验=0.046）。最后，1 小时血糖发现略高于 50%的由空腹或 2 小时血糖水平无法识别的心血管终点事件。
我们的研究结果支持早期研究结果，即 1 小时血糖可能比空腹或 2 小时血糖更能长期预测心血管发病率和死亡率。
除了传统的心血管危险因素外，1 小时负荷后血糖似乎是心血管事件的独立预测因素，并且似乎改善了传统心血管风险模型的预测能力。升高的 1 小时负荷后血糖发现了大量（略高于 50%）由空腹或 2 小时负荷后血糖水平无法识别的心血管终点事件。1 小时血糖似乎比空腹或 2 小时负荷后血糖更能长期预测心血管发病率和死亡率。
