Lin Yifen, Zhong Xiangbin, Xiong Zhenyu, Zhang Shaozhao, Liu Menghui, Fan Yongqiang, Huang Yiquan, Sun Xiuting, Zhou Huimin, Xu Xingfeng, Guo Yue, Li Yuqi, Yang Daya, Ye Xiaomin, Zhuang Xiaodong, Liao Xinxue
Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China.
Front Physiol. 2021 Jun 23;12:614532. doi: 10.3389/fphys.2021.614532. eCollection 2021.
To determine whether long-term intensity of glycemic exposure (IGE) during young adulthood is associated with multiple target organs function at midlife independent of single fasting glucose (FG) measurement.
We included 2,859 participants, aged 18-30 years at Y0, in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. IGE was calculated as the sum of (average FG of two consecutive examinations × years between the examinations) over 25 years. Target organs function was indicated by cardiac structure, left ventricular (LV) systolic function, LV diastolic function, coronary artery calcium (CAC), and urine albumin-to-creatinine ratio (UACR) at Y25. We evaluated the associations between IGE with target organs function using linear regression models and estimated the associations between IGE with numbers of organs involved (0, 1, or ≥ 2 organs) using multinomial logistic regression models.
A 1-SD increment of IGE was significantly associated with worse target organs function after multivariable adjustment: left ventricular mass (β [SE], 5.468 [1.175]); global longitudinal strain (β [SE], 0.161 [0.071]); E/e' ratio (β[SE], 0.192 [0.071]); CAC score (β [SE], 27.948 [6.116]); and log UACR (β [SE], 0.076 [0.010]). Besides, IGE was independently associated with having ≥ 2 organs involved in both overall population (OR [95% CI], 1.48 [1.23, 1.41], < 0.001) and subgroups stratified by diabetes at Y25.
Higher intensity of glycemic exposure during young adulthood was independently associated with subclinical alterations of target organs function at midlife. Our findings highlight the importance of early screening and management of IGE in youth.
确定青年期长期血糖暴露强度（IGE）是否与中年时多个靶器官功能相关，而独立于单次空腹血糖（FG）测量结果。
我们纳入了青年动脉粥样硬化风险发展研究（CARDIA研究）中2859名在Y0时年龄为18 - 30岁的参与者。IGE计算为25年间（连续两次检查的平均FG×两次检查间隔的年数）之和。Y25时通过心脏结构、左心室（LV）收缩功能、LV舒张功能、冠状动脉钙化（CAC）和尿白蛋白与肌酐比值（UACR）来表示靶器官功能。我们使用线性回归模型评估IGE与靶器官功能之间的关联，并使用多项逻辑回归模型估计IGE与受累器官数量（0、1或≥2个器官）之间的关联。
在多变量调整后，IGE每增加1个标准差与更差的靶器官功能显著相关：左心室质量（β[标准误]，5.468[1.175]）；整体纵向应变（β[标准误]，0.161[0.071]）；E/e'比值（β[标准误]，0.192[0.071]）；CAC评分（β[标准误]，27.948[6.116]）；以及log UACR（β[标准误]，0.076[0.010]）。此外，IGE在总体人群（比值比[95%置信区间]，1.48[1.23，1.41]，P<0.001）以及按Y25时糖尿病分层的亚组中均与≥2个器官受累独立相关。
青年期较高的血糖暴露强度与中年时靶器官功能的亚临床改变独立相关。我们的研究结果强调了青年期早期筛查和管理IGE的重要性。
