Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin 150001, Nangang, China.
Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin 150001, Nangang, China.
J Clin Endocrinol Metab. 2022 Nov 23;107(11):3055-3065. doi: 10.1210/clinem/dgac504.
The evidence regarding bicarbonate status and mortality among diabetes is scarce.
The purpose of this study was to investigate the associations of bicarbonate concentrations with risk of all-cause, cardiovascular disease (CVD), and cancer mortality among patients with type 2 diabetes (T2D).
This study included 8163 adult diabetic patients from the National Health and Nutrition Examination Survey (NHANES), 1999 to 2018. Death outcomes were ascertained by linkage to National Death Index records through 31 December 2019. The Cox proportional-risk model was used to estimate hazard ratios (HR) and 95% CIs for mortality from all causes, CVD, and cancer. The mediating effects of 11 metabolic, cardiovascular, and renal biomarkers were evaluated using a logistic regression model within a counterfactual framework.
During 8163 person-years of follow-up, 2310 deaths were documented, including 659 CVD deaths and 399 cancer deaths. After multivariate adjustment, lower serum bicarbonate levels were significantly linearly correlated with higher all-cause, CVD, and cancer mortality: The risk of all-cause death increased by 40%, the risk of CVD death increased by 48%, and the risk of cancer death increased by 84% compared with the normal group (all P < .05). Altered levels of estimated glomerular filtration rate explained 12.10% and 16.94% of the relation between serum bicarbonate with all-cause and CVD mortality, respectively. Total cholesterol mediated 4.70% and 10.51% of the associations of all-cause and CVD mortality, respectively.
Lower serum bicarbonate concentrations were significantly associated with higher all-cause, CVD, and cancer mortality. These findings suggest that maintaining adequate bicarbonate status may lower mortality risk in individuals with T2D.
关于糖尿病患者的碳酸氢盐状态和死亡率的证据很少。
本研究旨在探讨碳酸氢盐浓度与 2 型糖尿病（T2D）患者全因、心血管疾病（CVD）和癌症死亡率风险的相关性。
本研究纳入了来自 1999 年至 2018 年全国健康与营养调查（NHANES）的 8163 名成年糖尿病患者。通过与国家死亡指数记录的链接，截至 2019 年 12 月 31 日确定死亡结局。使用 Cox 比例风险模型估计全因、CVD 和癌症死亡率的风险比（HR）和 95%置信区间（CI）。在反事实框架内使用逻辑回归模型评估 11 种代谢、心血管和肾脏生物标志物的中介效应。
在 8163 人年的随访期间，记录了 2310 例死亡，包括 659 例 CVD 死亡和 399 例癌症死亡。经过多变量调整后，较低的血清碳酸氢盐水平与全因、CVD 和癌症死亡率的升高呈显著线性相关：全因死亡风险增加 40%，CVD 死亡风险增加 48%，癌症死亡风险增加 84%与正常组相比（均 P <.05）。估计肾小球滤过率的改变分别解释了血清碳酸氢盐与全因和 CVD 死亡率之间关系的 12.10%和 16.94%。总胆固醇分别介导了全因和 CVD 死亡率相关性的 4.70%和 10.51%。
较低的血清碳酸氢盐浓度与全因、CVD 和癌症死亡率的升高显著相关。这些发现表明，维持足够的碳酸氢盐状态可能会降低 T2D 患者的死亡风险。
