Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan.
Kowa Company. Ltd, 10-4 Nihonbashi-honcho 3-chome, Chuo-ku, Tokyo, 103-0023, Japan.
Cardiovasc Diabetol. 2021 Sep 3;20(1):174. doi: 10.1186/s12933-021-01367-7.
Although both a history of cerebrovascular disease (CVD) and glucose abnormality are risk factors for CVD, few large studies have examined their association with subsequent CVD in the same cohort. Thus, we compared the impact of prior CVD, glucose status, and their combinations on subsequent CVD using real-world data.
This is a retrospective cohort study including 363,627 men aged 18-72 years followed for ≥ 3 years between 2008 and 2016. Participants were classified as normoglycemia, borderline glycemia, or diabetes defined by fasting plasma glucose, HbA1c, and antidiabetic drug prescription. Prior and subsequent CVD (i.e. ischemic stroke, transient ischemic attack, and non-traumatic intracerebral hemorrhage) were identified according to claims using ICD-10 codes, medical procedures, and questionnaires.
Participants' mean age was 46.1 ± 9.3, and median follow up was 5.2 (4.2, 6.7) years. Cox regression analysis showed that prior CVD + conferred excess risk for CVD regardless of glucose status (normoglycemia: hazard ratio (HR), 8.77; 95% CI 6.96-11.05; borderline glycemia: HR, 7.40, 95% CI 5.97-9.17; diabetes: HR, 5.73, 95% CI 4.52-7.25). Compared with normoglycemia, borderline glycemia did not influence risk of CVD, whereas diabetes affected subsequent CVD in those with CVD- (HR, 1.50, 95% CI 1.34-1.68). In CVD-/diabetes, age, current smoking, systolic blood pressure, high-density lipoprotein cholesterol, and HbA1c were associated with risk of CVD, but only systolic blood pressure was related to CVD risk in CVD + /diabetes.
Prior CVD had a greater impact on the risk of CVD than glucose tolerance and glycemic control. In participants with diabetes and prior CVD, systolic blood pressure was a stronger risk factor than HbA1c. Individualized treatment strategies should consider glucose tolerance status and prior CVD.
虽然脑血管疾病（CVD）病史和血糖异常都是 CVD 的危险因素，但很少有大型研究在同一队列中比较它们与随后 CVD 的相关性。因此，我们使用真实世界的数据比较了既往 CVD、血糖状态及其组合对随后 CVD 的影响。
这是一项回顾性队列研究，纳入了 2008 年至 2016 年期间年龄在 18-72 岁之间、随访时间≥3 年的 363627 名男性。参与者根据空腹血糖、糖化血红蛋白和抗糖尿病药物的处方被分为正常血糖、边缘性血糖或糖尿病。根据 ICD-10 编码、医疗程序和问卷调查，使用索赔来确定既往和随后的 CVD（即缺血性中风、短暂性脑缺血发作和非创伤性颅内出血）。
参与者的平均年龄为 46.1±9.3 岁，中位随访时间为 5.2（4.2，6.7）年。Cox 回归分析显示，既往 CVD+无论血糖状态如何，均会增加 CVD 的风险（正常血糖：危险比（HR）8.77；95%CI 6.96-11.05；边缘性血糖：HR 7.40；95%CI 5.97-9.17；糖尿病：HR 5.73；95%CI 4.52-7.25）。与正常血糖相比，边缘性血糖不会影响 CVD 的风险，而糖尿病会影响 CVD-患者的后续 CVD（HR 1.50；95%CI 1.34-1.68）。在 CVD-/糖尿病患者中，年龄、当前吸烟、收缩压、高密度脂蛋白胆固醇和糖化血红蛋白与 CVD 风险相关，但仅收缩压与 CVD+/糖尿病患者的 CVD 风险相关。
既往 CVD 对 CVD 风险的影响大于血糖耐量和血糖控制。在患有糖尿病和既往 CVD 的患者中，收缩压是比糖化血红蛋白更强的危险因素。个体化治疗策略应考虑血糖耐量状态和既往 CVD。
