REWIND 试验中认知障碍和心血管事件的新指标。

Novel Indices of Cognitive Impairment and Incident Cardiovascular Outcomes in the REWIND Trial.

机构信息

Endocrinology Institute, Sheba Medical Center, Ramat-Gan, and Epidemiology Department, Sackler School of Medicine, Herceg Institute of Aging, Tel Aviv University, Tel Aviv, Israel.

Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada.

出版信息

J Clin Endocrinol Metab. 2022 Jul 14;107(8):e3448-e3454. doi: 10.1210/clinem/dgac200.

DOI:10.1210/clinem/dgac200

PMID:35446415

Abstract

CONTEXT

Low cognitive scores are risk factors for cardiovascular outcomes. Whether this relationship is stronger using novel cognitive indices is unknown.

METHODS

Participants in the Researching Cardiovascular Events with a Weekly Incretin in Diabetes (REWIND) trial who completed both the Montreal Cognitive Assessment (MoCA) score and Digit Substitution Test (DSST) at baseline (N = 8772) were included. These scores were used to identify participants with baseline substantive cognitive impairment (SCI), defined as a baseline score on either the MoCA or DSST ≥ 1.5 SD below either score's country-specific mean, or SCI-GM, which was based on a composite index of both scores calculated as their geometric mean (GM), and defined as a score that was ≥ 1.5 SD below their country's average GM. Relationships between these measures and incident major adverse cardiovascular events (MACE), and either stroke or death were analyzed.

RESULTS

Compared with 7867 (89.7%) unaffected participants, the 905 (10.3%) participants with baseline SCI had a higher incidence of MACE (unadjusted hazard ratio [HR] 1.34; 95% CI 1.11, 1.62; P = 0.003), and stroke or death (unadjusted HR 1.60; 95% CI 1.33, 1.91; P < 0.001). Stronger relationships were noted for SCI-GM and MACE (unadjusted HR 1.61; 95% CI 1.28, 2.01; P < 0.001), and stroke or death (unadjusted HR 1.85; 95% CI 1.50, 2.30; P < 0.001). For SCI-GM but not SCI, all these relationships remained significant in models that adjusted for up to 10 SCI risk factors.

CONCLUSION

Country-standardized SCI-GM was a strong independent predictor of cardiovascular events in people with type 2 diabetes in the REWIND trial.

摘要

背景

认知评分较低是心血管结局的危险因素。使用新的认知指数，这种关系是否更强尚不清楚。

方法

在 Researching Cardiovascular Events with a Weekly Incretin in Diabetes（REWIND）试验中，参与者在基线时完成了蒙特利尔认知评估（MoCA）评分和数字替代测试（DSST）（N=8772）。这些评分用于确定基线时存在实质性认知障碍（SCI）的参与者，定义为 MoCA 或 DSST 中的任何一个评分低于该评分的国家特定平均值的 1.5 个标准差，或 SCI-GM，这是基于两个评分的复合指数，计算为它们的几何平均值（GM），定义为低于其国家平均 GM 的 1.5 个标准差的评分。分析这些措施与主要不良心血管事件（MACE），以及中风或死亡之间的关系。

结果

与 7867（89.7%）未受影响的参与者相比，905（10.3%）基线时存在 SCI 的参与者 MACE 的发生率更高（未调整的危险比[HR]1.34；95%CI1.11，1.62；P=0.003），以及中风或死亡（未调整的 HR 1.60；95%CI1.33，1.91；P<0.001）。在 SCI-GM 与 MACE（未调整的 HR 1.61；95%CI1.28，2.01；P<0.001）和中风或死亡（未调整的 HR 1.85；95%CI1.50，2.30；P<0.001）方面，关系更强。对于 SCI-GM，但不是 SCI，在调整多达 10 个 SCI 风险因素的模型中，所有这些关系仍然具有统计学意义。