Health Economics Research Centre, University of Oxford, Oxford, UK.
Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
J Diabetes. 2022 Jul;14(7):455-464. doi: 10.1111/1753-0407.13294.
We estimate health-related quality of life and the impact of four cardiovascular events (myocardial infarction [MI], stroke, congestive heart failure, angina) and gastrointestinal events in 6522 Chinese patients with coronary heart disease (CHD) and impaired glucose tolerance (IGT) participating in the Acarbose Cardiovascular Evaluation (ACE) trial.
Health-related quality of life was captured using the EuroQol-5 Dimension-3 Level (EQ-5D-3L), with data collected at baseline and throughout the trial. Multilevel mixed-effects linear regression with random effects estimated health-related quality of life over time, capturing variation between hospital sites and individuals, and a fixed-effects linear model estimated the impact of cardiovascular and gastrointestinal events.
Patients were followed for a median of 5 years (interquartile range 3.4-6.0). The average baseline EQ-5D score of 0.930 (SD 0.104) remained relatively unchanged over the trial period with no evidence of statistically significant differences in EQ-5D score between randomized treatment groups. The largest decrement in the year of an event was estimated for stroke (-0.107, P < .001), followed by heart failure (-0.039, P = .022), MI (-0.021, P = .047), angina (-0.012, P = .047), and gastrointestinal events (-0.005, P = .430). MI and stroke reduced health-related quality of life beyond the year in which the event occurred (-0.031, P = .006, and -0.067, P < .001, respectively).
Acarbose treatment had no impact on health-related quality of life in ACE trial participants with CHD and IGT. Events such as MI, stroke, heart failure, and angina reduce health-related quality of life around the time they occurred, but only MI and stroke impacted on longer-term health-related quality of life.
我们评估了 6522 例中国冠心病（CHD）合并糖耐量受损（IGT）患者的健康相关生活质量，以及 4 种心血管事件（心肌梗死[MI]、中风、充血性心力衰竭、心绞痛）和胃肠道事件的影响，他们参与了阿卡波糖心血管评估（ACE）试验。
采用欧洲五维健康量表 3 级（EQ-5D-3L）评估健康相关生活质量，在基线和整个试验期间收集数据。采用多水平混合效应线性回归模型进行随机效应估计，以捕捉医院和个体之间的差异，采用固定效应线性模型估计心血管和胃肠道事件的影响。
患者中位随访时间为 5 年（四分位距 3.4-6.0）。试验期间，平均基线 EQ-5D 评分为 0.930（SD 0.104），相对稳定，随机治疗组间 EQ-5D 评分无统计学差异。在发生事件的那一年，估计中风的健康相关生活质量下降最大（-0.107，P < .001），其次是心力衰竭（-0.039，P = .022）、MI（-0.021，P = .047）、心绞痛（-0.012，P = .047）和胃肠道事件（-0.005，P = .430）。MI 和中风导致健康相关生活质量在发生事件的那一年之后也有所下降（-0.031，P = .006，和-0.067，P < .001）。
在 ACE 试验中，阿卡波糖治疗对 CHD 合并 IGT 患者的健康相关生活质量没有影响。MI、中风、心力衰竭和心绞痛等事件会降低发生时的健康相关生活质量，但只有 MI 和中风对长期健康相关生活质量有影响。
