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稳定型心血管疾病患者中新发现的异常葡萄糖耐量的长期预后意义:基于人群的队列研究。

Long term prognostic implication of newly detected abnormal glucose tolerance among patients with stable cardiovascular disease: a population-based cohort study.

机构信息

Metabolic Disorders Research Center, Golestan University of Medical Sciences, Gorgan, Iran.

Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Yamen Street, Velenjak, P.O. Box: 19395-4763, Tehran, Iran.

出版信息

J Transl Med. 2021 Jun 30;19(1):277. doi: 10.1186/s12967-021-02950-y.


DOI:10.1186/s12967-021-02950-y
PMID:34193200
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8243871/
Abstract

BACKGROUND: Fasting plasma glucose (FPG) and 2-h post challenge plasma glucose (2 h-PCPG), whether as continuous or categorical variables, are associated with incident cardiovascular disease (CVD) and diabetes; however, their role among patients with existing CVD is a matter of debate. We aimed to evaluate associations of different glucose intolerance states with recurrent CVD and incident diabetes among subjects with previous CVD. METHODS: From a prospective population-based cohort, 408 Iranians aged  ≥  30 years, with history of CVD and without known diabetes were included. Associations of impaired fasting glucose (IFG) according to the American Diabetes Association (ADA) and World Health Organization (WHO) criteria, impaired glucose tolerance (IGT), newly diagnosed diabetes (NDM) with outcomes of interest were determined by multivariable Cox proportional hazard models after adjustment for traditional risk factors. Furthermore, FPG and 2 h-PCPG were entered as continuous variables. RESULTS: Over a decade of follow-up, 220 CVD events including 89 hard events (death, myocardial infarction and stroke) occurred. Regarding prediabetes, only IFG-ADA was associated with increased risk of hard CVD [hazard ratio(HR), 95%CI: 1.62,1.03-2.57] in the age-sex adjusted model. In patients with NDM, those with FPG ≥ 7 mmol/L were at higher risk of incident CVD/coronary heart disease(CHD) and their related hard outcomes (HR ranged from 1.89 to 2.84, all P < 0.05). Moreover, those with 2 h-PCPG ≥ 11.1 mmol/L had significant higher risk of CVD (1.46,1.02-2.11), CHD (1.46,1.00-2.15) and hard CHD (1.95:0.99-3.85, P = 0.05). In the fully adjusted model, each 1 SD increase in FPG was associated with 20, 27, 15 and 25% higher risk of CVD, hard CVD, CHD and hard CHD, respectively; moreover each 1 SD higher 2 h-PCPG was associated with 21% and 16% higher risk of CVD, and CHD, respectively. Among individuals free of diabetes at baseline (n = 361), IFG-ADA, IFG-WHO and IGT were significantly associated with incident diabetes (all P < 0.05); significant associations were also found for FPG and 2 h-PCPG as continuous variables (all HRs for 1-SD increase > 2, P < 0.05). CONCLUSIONS: Among subjects with stable CVD, NDM whether as high FPG or 2 h-PCPG, but not pre-diabetes status was significantly associated with CVD/CHD and related hard outcomes.

摘要

背景:空腹血糖(FPG)和 2 小时餐后血糖(2 h-PCPG)无论是作为连续变量还是分类变量,都与心血管疾病(CVD)和糖尿病的发病有关;然而,它们在已有 CVD 的患者中的作用仍存在争议。我们旨在评估不同葡萄糖耐量状态与既往 CVD 患者复发性 CVD 和新发糖尿病之间的关系。

方法:从一个前瞻性的基于人群的队列中,纳入了 408 名年龄≥30 岁、有 CVD 病史且无已知糖尿病的伊朗人。根据美国糖尿病协会(ADA)和世界卫生组织(WHO)标准,评估空腹血糖受损(IFG)、葡萄糖耐量受损(IGT)和新诊断糖尿病(NDM)与结局的关系,采用多变量 Cox 比例风险模型进行调整,以调整传统危险因素。此外,FPG 和 2 h-PCPG 被作为连续变量纳入。

结果:在 10 多年的随访中,发生了 220 例 CVD 事件,其中 89 例为硬终点事件(死亡、心肌梗死和中风)。关于糖尿病前期,仅 ADA 定义的 IFG 与硬终点 CVD 的风险增加相关(风险比[HR],95%置信区间:1.62,1.03-2.57),在年龄和性别调整模型中。在 NDM 患者中,FPG≥7 mmol/L 的患者发生 CVD/冠心病(CHD)和相关硬终点事件的风险更高(HR 范围为 1.89 至 2.84,均 P<0.05)。此外,2 h-PCPG≥11.1 mmol/L 的患者发生 CVD 的风险显著增加(1.46,1.02-2.11)、CHD(1.46,1.00-2.15)和硬 CHD(1.95:0.99-3.85,P=0.05)。在完全调整模型中,FPG 每增加 1 个标准差,分别与 CVD、硬 CVD、CHD 和硬 CHD 的风险增加 20%、27%、15%和 25%相关;此外,2 h-PCPG 每增加 1 个标准差,与 CVD 和 CHD 的风险增加 21%和 16%相关。在基线无糖尿病的个体中(n=361),ADA 定义的 IFG、WHO 定义的 IFG 和 IGT 与新发糖尿病显著相关(均 P<0.05);FPG 和 2 h-PCPG 作为连续变量也存在显著相关性(1-SD 增加的所有 HR 值均>2,P<0.05)。

结论:在稳定 CVD 的患者中,NDM 无论是高 FPG 还是 2 h-PCPG,而不是糖尿病前期状态,均与 CVD/CHD 和相关硬终点显著相关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/056c/8243871/d574f6b44dc7/12967_2021_2950_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/056c/8243871/eeb26a3ad5de/12967_2021_2950_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/056c/8243871/bbf437a021d4/12967_2021_2950_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/056c/8243871/d574f6b44dc7/12967_2021_2950_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/056c/8243871/eeb26a3ad5de/12967_2021_2950_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/056c/8243871/bbf437a021d4/12967_2021_2950_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/056c/8243871/d574f6b44dc7/12967_2021_2950_Fig3_HTML.jpg

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Change in glucose intolerance status and risk of incident cardiovascular disease: Tehran Lipid and Glucose Study.

Cardiovasc Diabetol. 2020-3-30

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