He Panpan, Gan Xiaoqin, Wu Qimeng, Ye Ziliang, Yang Sisi, Zhang Yanjun, Li Huan, Zhou Chun, Zhang Yuanyuan, Liu Mengyi, Qin Xianhui
Division of Nephrology, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangdong Provincial Institute of Nephrology, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, 510515, China.
Diabetol Metab Syndr. 2022 Sep 19;14(1):132. doi: 10.1186/s13098-022-00905-x.
We aimed to investigate the joint effect of visit-to-visit variability (VVV) in low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides and glycosylated hemoglobin (HbA1c) on cardiovascular mortality and total mortality in patients with diabetes.
Among 5194 participants with type 2 diabetes enrolled in the ACCORD lipid trial, VVVs of LDL-C, triglycerides, HDL-C, and HbA1c were assessed from baseline to 2 years of follow-up and expressed as coefficient of variation (CV). The study outcomes included cardiovascular mortality and all-cause mortality.
Over a median follow-up of 3.0 years from the end of variability measurements at years 2, there were 305 (5.9%) cases of all-cause mortality, of which, 144 were cardiovascular causes. The positive relations between LDL-C CV and cardiovascular mortality were significantly stronger among participants with higher HDL-C CV (P for interaction = 0.023), and higher HbA1c CV (P for interaction = 0.015). However, there were no significant interactions between LDL-C CV and triglycerides CV (P for interaction = 0.591). Similar trends were found for all-cause mortality. Consistently, there were graded trends in the risk of mortality with the increasing numbers of higher CV of the three variables: LDL-C, HbA1c, and HDL-C (P for trend = 0.008 for cardiovascular mortality, and P for trend < 0.001 for all-cause mortality).
VVVs in LDL-C, HDL-C, and HbA1c may jointly affect the risks of cardiovascular and all-cause mortality in diabetes patients. Those with higher CVs of all three variables had the highest risks of cardiovascular and all-cause mortality.
我们旨在研究低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、甘油三酯和糖化血红蛋白（HbA1c）的就诊间变异性（VVV）对糖尿病患者心血管死亡率和总死亡率的联合影响。
在参加ACCORD血脂试验的5194名2型糖尿病参与者中，评估了从基线到随访2年期间LDL-C、甘油三酯、HDL-C和HbA1c的VVV，并表示为变异系数（CV）。研究结局包括心血管死亡率和全因死亡率。
在从第2年变异性测量结束起的中位随访3.0年期间，有305例（5.9%）全因死亡病例，其中144例为心血管原因。在HDL-C变异系数较高（交互作用P=0.023）和HbA1c变异系数较高（交互作用P=0.015）的参与者中，LDL-C变异系数与心血管死亡率之间的正相关关系显著更强。然而，LDL-C变异系数与甘油三酯变异系数之间无显著交互作用（交互作用P=0.591）。全因死亡率也发现了类似趋势。一致地，随着LDL-C、HbA1c和HDL-C这三个变量中较高变异系数数量的增加，死亡率风险呈分级趋势（心血管死亡率趋势P=0.008，全因死亡率趋势P<0.001）。
LDL-C、HDL-C和HbA1c的VVV可能共同影响糖尿病患者心血管和全因死亡风险。这三个变量变异系数均较高的患者心血管和全因死亡风险最高。
