Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Cardiovasc Diabetol. 2022 Aug 10;21(1):153. doi: 10.1186/s12933-022-01592-8.
Prediabetes is an important risk factor of cardiovascular disease (CVD) and is associated with subclinical atherosclerosis. However, the evidence of prediabetes as a cardiovascular risk factor is mainly derived from middle-aged adults. Recently, multiple studies supported that prediabetes in older adults would not lead to higher risk of CVD or mortality. We aimed to investigate the age-specific difference in the association between prediabetes and subclinical atherosclerosis in a Chinese prospective cohort study.
We included 4739 individuals aged ≥ 40 years and without diagnosed diabetes or CVD history, and divided them into middle-aged adults (age < 60) and older adults (age ≥ 60). Fasting plasma glucose (FPG), 2-h post-load plasma glucose (2 h-PPG) and glycated hemoglobin (HbA1c) were measured at baseline to identify prediabetes status. At follow-up visits, subclinical atherosclerosis status was assessed by branchial-ankle pulse wave velocity (baPWV) and carotid intima-media thickness (CIMT). Logistic regression analysis, restricted cubic splines and cross-lagged path analysis were used in statistical analysis.
1634 participants aged over 60 years, and 64.3% of them had prediabetes. 3105 participants aged 40-59 years, and 49.3% of them had prediabetes. We found that prediabetes was associated with increased risk of subclinical atherosclerosis in middle-aged adults, but the association attenuated substantially in older adults. Impaired glucose tolerance (IGT), compared to normal glucose tolerance, was associated with 39% lower risk of increased baPWV only in older adults. In accordance, the association between 2 h-PPG and risk of increased baPWV was "U-shaped" in older adults, while risk of elevated baPWV increased linearly with 2 h-PPG in middle-aged adults. In the cross-lagged analysis, increase in FPG and 2 h-PPG tended not to precede increase in baPWV in older adults, but appeared to increase simultaneously with baPWV in middle-aged ones.
Our results indicated that prediabetes might be less related to subclinical atherosclerosis in older adults than in middle-aged adults and suggested that age was important to consider in the care of adults with prediabetes.
糖尿病前期是心血管疾病（CVD）的一个重要危险因素，与亚临床动脉粥样硬化有关。然而，糖尿病前期作为心血管危险因素的证据主要来自于中年人群。最近，多项研究表明，老年人的糖尿病前期不会导致更高的 CVD 或死亡率风险。我们旨在通过一项中国前瞻性队列研究来探究糖尿病前期与亚临床动脉粥样硬化之间的关联在不同年龄组之间的差异。
我们纳入了 4739 名年龄≥40 岁且无诊断为糖尿病或 CVD 病史的个体，并将其分为中年组（年龄＜60 岁）和老年组（年龄≥60 岁）。在基线时测量空腹血糖（FPG）、餐后 2 小时血糖（2 h-PPG）和糖化血红蛋白（HbA1c）以确定糖尿病前期状态。在随访期间，通过臂踝脉搏波速度（baPWV）和颈动脉内膜中层厚度（CIMT）评估亚临床动脉粥样硬化状况。使用逻辑回归分析、限制性三次样条和交叉滞后路径分析进行统计分析。
共纳入了 1634 名年龄超过 60 岁的参与者，其中 64.3%患有糖尿病前期。纳入了 3105 名年龄在 40-59 岁的参与者，其中 49.3%患有糖尿病前期。我们发现，糖尿病前期与中年人群亚临床动脉粥样硬化风险增加有关，但在老年人群中这种关联显著减弱。与正常糖耐量相比，葡萄糖耐量受损（IGT）仅与老年人群中 baPWV 增加的风险降低 39%有关。相应地，老年人群中 2 h-PPG 与 baPWV 升高风险之间呈“U 型”关系，而中年人群中 baPWV 升高的风险则随 2 h-PPG 线性增加。在交叉滞后分析中，FPG 和 2 h-PPG 的增加趋势并未先于老年人群中 baPWV 的增加，而在中年人群中，FPG 和 2 h-PPG 的增加似乎与 baPWV 同时增加。
我们的研究结果表明，与中年人群相比，老年人群的糖尿病前期与亚临床动脉粥样硬化的相关性可能较低，这表明年龄是考虑患有糖尿病前期的成年人的重要因素。
