2 型糖尿病成人的体重变化与心血管疾病风险：德黑兰血脂和血糖研究超过 14 年的随访。

Weight change and risk of cardiovascular disease among adults with type 2 diabetes: more than 14 years of follow-up in the Tehran Lipid and Glucose Study.

机构信息

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

Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran.

出版信息

Cardiovasc Diabetol. 2021 Jul 12;20(1):141. doi: 10.1186/s12933-021-01326-2.

BACKGROUND

To examine the impact of weight change on incident cardiovascular disease and coronary heart disease (CVD/CHD) among an Iranian population with type 2 diabetes mellitus (T2DM).

METHODS

The study population included 763 participants with T2DM aged ≥ 30 years without a history of CVD and cancer at baseline. Two weight measurements done at baseline and about 3 years later. Based on their weight change, they categorized into: > 5% loss, 3-5% loss, stable (± < 3%), 3-5% gain, > 5% gain. Participants were then followed for incident CVD/CHD annually up to 20 March 2018. Multivariable Cox proportional hazard models, adjusted for age, sex, body mass index, educational level, current smoking, glucose-lowering drug use, family history of CVD, hypertension, hypercholesterolemia, chronic kidney disease, and fasting plasma glucose (FPG) were applied to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of weight change categories for incident CVD/CHD, considering stable weight as reference.

RESULTS

After the weight change measurement, during a median follow-up of 14.4 years, 258 CVD and 214 CHD occurred. Over 5% weight gain was associated with reduced risks of CVD and CHD development by the HRs of 0.70 [95% CI 0.48-1.01; P-value: 0.058] and 0.61 [0.40-0.93], respectively, in multivariable analysis. After further adjustment for FPG change, the HRs of weight gain > 5% were attenuated to 0.75 [0.51-1.10; P-value: 0.138] and 0.66 [043-1.01; P-value: 0.053] for incident CVD and CHD, respectively. The effect of weight loss > 5% was in opposite direction among those older versus younger than 60 years; with suggestive increased risk (not statistically significant) of incident CHD/CVD for the older group. Moreover, weight gain > 5% significantly reduced the risk of CHD only among those older than 60 years (P-value for interaction < 0.2). Furthermore, weight gain > 5% had an association with lower risk of CVD and CHD among sulfonylurea users (0.56 [0.32-0.98] for CVD and 0.54 [0.29-0.99] for CHD).

CONCLUSIONS

Our results with a long-term follow-up showed that weight gain > 5% was associated with better CVD/CHD outcomes among Iranian participants with T2DM, especially older ones. Moreover, we did not find an unfavorable impact on incident CVD/CHD for sulfonylurea-induced weight gain.

背景

研究体重变化对伊朗 2 型糖尿病（T2DM）患者发生心血管疾病（CVD/CHD）的影响。

方法

本研究纳入了 763 名年龄≥30 岁、无 CVD 和癌症病史的 T2DM 患者。基线和大约 3 年后进行了两次体重测量。根据体重变化，将其分为：体重减轻>5%、体重减轻 3-5%、体重稳定（±<3%）、体重增加 3-5%、体重增加>5%。然后，对参与者进行每年一次的 CVD/CHD 事件随访，截至 2018 年 3 月 20 日。多变量 Cox 比例风险模型，根据年龄、性别、体重指数、教育水平、当前吸烟、降糖药物使用、CVD 家族史、高血压、高胆固醇血症、慢性肾脏病和空腹血糖（FPG）进行调整，用于估计体重变化类别的风险比（HRs）和 95%置信区间（CIs），以稳定体重为参考。

结果

在体重变化测量后，中位随访 14.4 年后，发生了 258 例 CVD 和 214 例 CHD。多变量分析显示，体重增加>5%与 CVD 和 CHD 发展的风险降低相关，风险比（HRs）分别为 0.70（95%CI 0.48-1.01；P 值：0.058）和 0.61（0.40-0.93）。进一步调整 FPG 变化后，体重增加>5%的 HR 分别为 0.75（0.51-1.10；P 值：0.138）和 0.66（0.43-1.01；P 值：0.053），与 CVD 和 CHD 的发生风险相关。体重减轻>5%的效果在 60 岁以上和以下的人群中是相反的；对于年龄较大的人群，CHD/CVD 的发生风险有增加的趋势（但无统计学意义）。此外，体重增加>5%仅在年龄大于 60 岁的人群中与 CHD 风险降低显著相关（交互作用检验 P 值<0.2）。此外，体重增加>5%与磺脲类药物使用者的 CVD 和 CHD 风险降低相关（CVD 为 0.56[0.32-0.98]，CHD 为 0.54[0.29-0.99]）。