Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea.
Endocrinol Metab (Seoul). 2021 Oct;36(5):1007-1015. doi: 10.3803/EnM.2021.1218. Epub 2021 Oct 21.
Metabolic abnormalities, such as impaired fasting glucose (IFG), are dynamic phenomena; however, it is unclear whether the timing of IFG exposure and cumulative exposure to IFG are related to cardiovascular disease (CVD) and mortality risk.
Data were extracted from a nationwide population-based cohort in South Korea for adults (n=2,206,679) who were free of diabetes and had 4 years of consecutive health examination data. Fasting blood glucose levels of 100 to 125 mg/dL were defined as IFG, and the number of IFG diagnoses for each adult in the 4-year period was tabulated as the IFG exposure score (range, 0 to 4). Adults with persistent IFG for the 4-year period received a score of 4.
The median follow-up was 8.2 years. There were 24,820 deaths, 13,502 cases of stroke, and 13,057 cases of myocardial infarction (MI). IFG exposure scores of 1, 2, 3, and 4 were associated with all-cause mortality (multivariable-adjusted hazard ratio [aHR], 1.11; 95% confidence interval [CI], 1.08 to 1.15; aHR, 1.16; 95% CI, 1.12 to 1.20; aHR, 1.20; 95% CI, 1.15 to 1.25; aHR, 1.18; 95% CI, 1.11 to 1.25, respectively) compared with an IFG exposure score of 0. Adjusting for hypertension and dyslipidemia attenuated the slightly increased risk of MI or stroke associated with high IFG exposure scores, but significant associations for allcause mortality remained.
The intensity of IFG exposure was associated with an elevated risk of all-cause mortality, independent of cardiovascular risk factors. The association between IFG exposure and CVD risk was largely mediated by the coexistence of dyslipidemia and hypertension.
代谢异常，如空腹血糖受损（IFG），是动态现象；然而，IFG 暴露的时间和 IFG 的累积暴露是否与心血管疾病（CVD）和死亡风险有关尚不清楚。
从韩国一项全国性的基于人群的成年人队列中提取数据（n=2,206,679），这些成年人无糖尿病且有 4 年连续体检数据。空腹血糖水平为 100 至 125mg/dL 定义为 IFG，4 年内每个成年人的 IFG 诊断次数被列在 IFG 暴露评分中（范围，0 至 4）。4 年内持续存在 IFG 的成年人得分为 4。
中位随访时间为 8.2 年。共有 24820 人死亡，13502 人发生中风，13057 人发生心肌梗死（MI）。IFG 暴露评分 1、2、3 和 4 与全因死亡率相关（多变量调整后的危险比[aHR]，1.11；95%置信区间[CI]，1.08 至 1.15；aHR，1.16；95%CI，1.12 至 1.20；aHR，1.20；95%CI，1.15 至 1.25；aHR，1.18；95%CI，1.11 至 1.25），与 IFG 暴露评分 0 相比。调整高血压和血脂异常后，IFG 高暴露评分与 MI 或中风风险增加略有相关，但全因死亡率仍存在显著相关性。
IFG 暴露强度与全因死亡率升高相关，与心血管危险因素无关。IFG 暴露与 CVD 风险之间的关联主要由血脂异常和高血压的共存介导。
