Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan.
Department of Metabolic Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan.
Acta Diabetol. 2022 Jan;59(1):57-65. doi: 10.1007/s00592-021-01773-z. Epub 2021 Aug 30.
Most risk calculators that predict future cardiovascular disease (CVD) by baseline profiles are originally developed for primary prevention, but some studies applied the calculators to secondary prevention. We compared the impact of baseline profiles on the future CVD risk between patients with diabetes with and without a CVD history.
We analyzed a multicenter prospective cohort of 6338 Japanese patients with diabetes aged 40-74 years, including those with (n = 634) and without a CVD history (n = 5704). The future risk of CVD was investigated using the competing risk model, with adjustment for non-cardiovascular mortality.
During the median follow-up of 6.9 years, 413 CVD events were observed. The 8-year cumulative incidence rates of CVD were 21.5% and 7.2% in patients with and without a CVD history, respectively. A higher systolic blood pressure and lower high-density lipoprotein cholesterol levels were independently associated with a future CVD risk in patients without a CVD history (both P < 0.05), whereas they were not associated in those with a CVD history. The P values for interaction were 0.040 and 0.005, respectively. The male sex, an older age, a longer duration of diabetes, higher hemoglobin A1c levels, and higher low-density lipoprotein cholesterol levels were common independent risk factors regardless of CVD history (all P < 0.05).
The prognostic impact of metabolic profiles on CVD risk would not be identical between patients with and without a CVD history, suggesting that it might be inappropriate to apply CVD risk calculators developed for primary prevention to patients with a CVD history.
大多数通过基线特征预测未来心血管疾病（CVD）风险的风险计算器最初是为一级预防而开发的，但有些研究将计算器应用于二级预防。我们比较了有和无 CVD 病史的糖尿病患者基线特征对未来 CVD 风险的影响。
我们分析了一个由 6338 名年龄在 40-74 岁的日本糖尿病患者组成的多中心前瞻性队列，包括有（n=634）和无 CVD 病史（n=5704）的患者。使用竞争风险模型评估未来 CVD 风险，调整非心血管死亡率。
在中位随访 6.9 年期间，观察到 413 例 CVD 事件。有和无 CVD 病史的患者 8 年累积 CVD 发生率分别为 21.5%和 7.2%。在无 CVD 病史的患者中，较高的收缩压和较低的高密度脂蛋白胆固醇水平与未来 CVD 风险独立相关（均 P<0.05），而在有 CVD 病史的患者中则无相关性。交互 P 值分别为 0.040 和 0.005。男性、年龄较大、糖尿病病程较长、糖化血红蛋白水平较高和低密度脂蛋白胆固醇水平较高是无论有无 CVD 病史的共同独立危险因素（均 P<0.05）。
代谢特征对 CVD 风险的预后影响在有和无 CVD 病史的患者之间可能并不相同，这表明将为一级预防开发的 CVD 风险计算器应用于有 CVD 病史的患者可能并不合适。
