糖化血红蛋白与无糖尿病患者的亚临床动脉粥样硬化。

Glycated Hemoglobin and Subclinical Atherosclerosis in People Without Diabetes.

机构信息

Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain; CIBER de Enfermedades CardioVasculares, Madrid, Spain; Cardiology Department, Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma, Spain. Electronic address: https://twitter.com/RosselloXavier.

Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain; Cardiology Department, University Hospital Álvaro Cunqueiro, Vigo, Spain.

出版信息

J Am Coll Cardiol. 2021 Jun 8;77(22):2777-2791. doi: 10.1016/j.jacc.2021.03.335.

DOI:10.1016/j.jacc.2021.03.335

PMID:34082907

Abstract

BACKGROUND

The metabolic injury caused by protein glycation, monitored as the level of glycated hemoglobin (HbA1c), is not represented in most risk scores (i.e., Systematic Coronary Risk Estimation or atherosclerotic cardiovascular disease risk scale).

OBJECTIVES

The purpose of this study was to assess the association between HbA1c and the extent of subclinical atherosclerosis (SA) and to better identify individuals at higher risk of extensive SA using HbA1c on top of key cardiovascular risk factors (CVRFs).

METHODS

A cohort of 3,973 middle-aged individuals from the PESA (Progression of Early Subclinical Atherosclerosis) study, with no history of cardiovascular disease and with HbA1c in the nondiabetic range, were assessed for the presence and extent of SA by 2-dimensional vascular ultrasound and noncontrast cardiac computed tomography.

RESULTS

After adjusting for established CVRFs, HbA1c showed an association with the multiterritorial extent of SA (odds ratio: 1.05, 1.27, 1.27, 1.36, 1.80, 1.87, and 2.47 for HbA1c 4.9% to 5.0%, 5.1% to 5.2%, 5.3% to 5.4%, 5.5% to 5.6%, 5.7% to 5.8%, 5.9% to 6.0%, and 6.1% to 6.4%, respectively; reference HbA1c ≤4.8%; p < 0.001). The association was significant in all pre-diabetes groups and even below the pre-diabetes cut-off (HbA1c 5.5% to 5.6% odds ratio: 1.36 [95% confidence interval: 1.03 to 1.80]; p = 0.033). High HbA1c was associated with an increased risk of SA in low-risk individuals (p < 0.001), but not in moderate-risk individuals (p = 0.335). Relative risk estimations using Systematic Coronary Risk Estimation or atherosclerotic cardiovascular disease predictors confirmed that inclusion of HbA1c modified the risk of multiterritorial SA in most risk categories.

CONCLUSIONS

Routine use of HbA1c can identify asymptomatic individuals at higher risk of SA on top of traditional CVRFs. Lifestyle interventions and novel antidiabetic medications might be considered to reduce both HbA1c levels and SA in individuals without diabetes.

摘要

背景

由蛋白质糖化引起的代谢损伤，通过糖化血红蛋白（HbA1c）水平来监测，在大多数风险评分中并未体现（即系统性冠状动脉风险评估或动脉粥样硬化性心血管疾病风险量表）。

目的

本研究旨在评估 HbA1c 与亚临床动脉粥样硬化（SA）程度之间的关系，并通过 HbA1c 结合关键心血管危险因素（CVRFs），更好地识别具有广泛 SA 风险的个体。

方法

来自 PESA（早期亚临床动脉粥样硬化进展）研究的 3973 名中年个体，无心血管疾病史且 HbA1c 在非糖尿病范围内，通过二维血管超声和非对比心脏计算机断层扫描评估 SA 的存在和程度。

结果

在调整了既定的 CVRFs 后，HbA1c 与多部位 SA 程度呈正相关（比值比：4.9%至 5.0%、5.1%至 5.2%、5.3%至 5.4%、5.5%至 5.6%、5.7%至 5.8%、5.9%至 6.0%和 6.1%至 6.4%，分别为 1.05、1.27、1.27、1.36、1.80、1.87 和 2.47；参考 HbA1c ≤4.8%；p<0.001）。这种关联在所有糖尿病前期组中均具有显著性，甚至在糖尿病前期切点以下（HbA1c 5.5%至 5.6%，比值比：1.36 [95%置信区间：1.03 至 1.80]；p=0.033）。HbA1c 升高与低危个体的 SA 风险增加相关（p<0.001），但与中危个体无关（p=0.335）。使用系统性冠状动脉风险评估或动脉粥样硬化性心血管疾病预测因子进行的相对风险估计证实，在大多数风险类别中，HbA1c 的纳入改变了多部位 SA 的风险。