Department of Medicine, The Ohio State University Wexner Medical Center, Columbus.
Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina.
JAMA Netw Open. 2022 Oct 3;5(10):e2238361. doi: 10.1001/jamanetworkopen.2022.38361.
A combination of diabetes, coronary heart disease (CHD), and stroke has multiplicative all-cause mortality risk compared with any individual morbidity in White populations, but there is a lack of studies in Black populations in the US.
To examine the association of cardiometabolic multimorbidity (diabetes, stroke, and CHD) individually and collectively with all-cause and CHD mortality.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included Black adults in the Jackson Heart Study followed over a median of 15 years. Baseline examinations were performed between 2000 and 2004, with follow-up on all-cause and CHD mortality through May 31, 2018. Participants were categorized into mutually exclusive groups at baseline: (1) free of cardiometabolic morbidity, (2) diabetes, (3) CHD, (4) stroke, (5) diabetes and stroke, (6) CHD and stroke, (7) diabetes and CHD, and (8) diabetes, stroke, and CHD. Data were analyzed from 2019 to 2021.
Cardiometabolic disease alone or in combination.
The main outcomes were all-cause mortality and CHD mortality. Cox models estimated hazard ratios (HRs) with 95% CIs adjusted for sociodemographic and cardiovascular risk factors.
Among 5064 participants (mean [SD] age, 55.4 [12.8] years; 3200 [63%] women) in the Jackson Heart Study, 897 (18%) had diabetes, 192 (4%) had CHD, and 104 (2%) had a history of stroke. Among participants with cardiometabolic morbidities, the crude all-cause mortality rates were lowest for diabetes alone (24.4 deaths per 1000 person-years) and highest for diabetes, CHD, and stroke combined (84.1 deaths per 1000 person-years). For people with only 1 cardiometabolic morbidity, risk for all-cause mortality was highest for people with stroke (HR, 1.74; 95% CI, 1.24-2.42), followed by CHD (HR, 1.59 (95% CI, 1.22-2.08) and diabetes (HR, 1.50; 95% CI, 1.22-1.85), compared with no cardiometabolic morbidities. There were also increased risks of mortality with combinations of diabetes and stroke (HR, 1.71; 95% CI, 1.09-2.68), CHD and stroke (HR, 2.23; 95% CI, 1.35-3.69), and diabetes and CHD (HR, 2.28; 95% CI, 1.65-3.15). The combination of diabetes, stroke, and CHD was associated with the highest all-cause mortality (HR, 3.68; 95% CI, 1.96-6.93). Findings were similar for CHD mortality, but with a larger magnitude of association (eg, diabetes, stroke, and CHD: HR, 13.52; 95% CI, 3.38-54.12).
In this cohort study, an increasing number of cardiometabolic multimorbidities was associated with a multiplicative increase in risk of all-cause mortality among Black adults, with a greater magnitude of association for CHD mortality.
在白人人群中，糖尿病、冠心病（CHD）和中风的组合与全因死亡率呈倍增关系，而在美国黑人人群中，缺乏相关研究。
研究心血管代谢性多种疾病（糖尿病、中风和 CHD）单独和共同与全因和冠心病死亡率的关系。
设计、地点和参与者：本队列研究纳入了美国杰克逊心脏研究中的黑人成年人，随访时间中位数为 15 年。基线检查于 2000 年至 2004 年进行，通过 2018 年 5 月 31 日对全因和冠心病死亡率进行随访。参与者在基线时分为相互排斥的组：（1）无心血管代谢性疾病，（2）糖尿病，（3）CHD，（4）中风，（5）糖尿病和中风，（6）CHD 和中风，（7）糖尿病和 CHD，以及（8）糖尿病、中风和 CHD。数据于 2019 年至 2021 年进行分析。
心血管代谢性疾病单独或联合。
主要结果是全因死亡率和冠心病死亡率。Cox 模型调整了社会人口统计学和心血管危险因素后，估计了风险比（HR）及其 95%置信区间。
在杰克逊心脏研究中的 5064 名参与者（平均[标准差]年龄 55.4[12.8]岁；3200[63%]名女性）中，897 名（18%）患有糖尿病，192 名（4%）患有 CHD，104 名（2%）有中风史。在患有心血管代谢性疾病的参与者中，单纯糖尿病的全因死亡率最低（每 1000 人年 24.4 例死亡），而糖尿病、CHD 和中风联合的死亡率最高（每 1000 人年 84.1 例死亡）。对于只有 1 种心血管代谢性疾病的患者，中风患者的全因死亡率风险最高（HR，1.74；95%CI，1.24-2.42），其次是 CHD（HR，1.59[95%CI，1.22-2.08]）和糖尿病（HR，1.50；95%CI，1.22-1.85），与无心血管代谢性疾病相比。糖尿病和中风（HR，1.71；95%CI，1.09-2.68）、CHD 和中风（HR，2.23[95%CI，1.35-3.69]）以及糖尿病和 CHD（HR，2.28[95%CI，1.65-3.15）的组合也增加了死亡风险。糖尿病、中风和 CHD 的组合与全因死亡率的相关性最高（HR，3.68；95%CI，1.96-6.93）。CHD 死亡率的发现类似，但关联幅度更大（例如，糖尿病、中风和 CHD：HR，13.52；95%CI，3.38-54.12）。
在这项队列研究中，心血管代谢性多种疾病的数量不断增加与黑人成年人全因死亡率的倍增风险相关，与冠心病死亡率的相关性更大。
