Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
State Key Laboratory of Cardiovascular Disease, Department of Cardiology, National Clinical Research Center of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Prim Care Diabetes. 2023 Oct;17(5):420-428. doi: 10.1016/j.pcd.2023.08.001. Epub 2023 Aug 10.
Vascular complications are the leading causes of reduced life quality and mortality in type 2 diabetes mellitus (T2DM). Life's Essential 8 (LE8) is a newly modified measurement of cardiovascular health (CVH) by American Heart Association (AHA). Promoting CVH has been previously shown to improve the prognosis of T2DM. However, studies regarding the effects of CVH by LE8 on diabetic retinopathy (DR), a major microvascular complication, and death from the cardiovascular and overall causes in T2DM are currently lacking. This study aimed to investigate these associations thus providing preliminary evidence.
A total of 3192 participants from the National Health and Nutrition Examination Survey (NHANES) were included in the final analysis. Records of mortality during follow-up were obtained by linking to the National Death Index. The multivariable logistic regression and Cox proportional hazard regression with restricted cubic splines were used to estimate the associations. Subgroup analyses were performed to examine the effects of gender, age, and duration of T2DM.
648 individuals had DR at baseline. During a median follow-up of 76 months, 645 overall deaths (incidence per 1000 person-years, 26.53%; 95% confidence interval (CI), 26.50-26.56) were ascertained, including 216 from cardiovascular causes (incidence per 1000 person-years, 8.96%; 95% CI, 8.94-8.98). The multivariable-adjusted odds ratio (OR) per 100-point increase of LE8 was 0.80 (95% CI, 0.71-0.90) for DR, and participants with high levels of LE8 were associated with 47% risk reduction (OR, 0.53; 95% CI, 0.40-0.70). The multivariable-adjusted hazard ratio (HR) per 100-point increase of LE8 was 0.71 (95% CI, 0.62-0.81) and 0.68 (95% CI, 0.58-0.85) for all-cause mortality and cardiovascular mortality, respectively. Similar patterns of inverse associations were observed in participants with moderate and high levels of LE8 for all-cause and cardiovascular mortality. Notably, stronger associations between LE8 and mortality were discovered in participants below 60 years (P < 0.05 for interaction). Moreover, LE8 was correlated with all-cause mortality in a linear way (P for nonlinear=0.32).
The AHA's newly prompted LE8 was strongly and inversely associated with the risk of DR, all-cause mortality, and cardiovascular-specific mortality in T2DM. LE8 may be a feasible and effective approach in the tertiary prevention of T2DM.
血管并发症是 2 型糖尿病（T2DM）患者生活质量和死亡率降低的主要原因。美国心脏协会（AHA）提出的生命必需 8 项（LE8）是一种新的心血管健康（CVH）测量方法。先前的研究表明，促进 CVH 可改善 T2DM 的预后。然而，目前缺乏关于 LE8 对糖尿病视网膜病变（DR）这一主要微血管并发症以及 T2DM 中心血管和总体原因导致的死亡风险的 CVH 影响的研究。本研究旨在探讨这些关联，从而提供初步证据。
共纳入来自国家健康和营养检查调查（NHANES）的 3192 名参与者，最终分析纳入了这些参与者的数据。通过与国家死亡索引链接，获得随访期间的死亡率记录。采用多变量逻辑回归和受限立方样条 Cox 比例风险回归来估计关联。进行亚组分析以检验性别、年龄和 T2DM 持续时间的影响。
基线时有 648 人患有 DR。在中位随访 76 个月期间，共确定了 645 例总死亡（每 1000 人年发生率为 26.53%，95%置信区间[CI]为 26.50-26.56），其中 216 例死于心血管原因（每 1000 人年发生率为 8.96%，95%CI 为 8.94-8.98）。LE8 每增加 100 分，DR 的多变量调整比值比（OR）为 0.80（95%CI，0.71-0.90），LE8 水平较高的患者与 47%的风险降低相关（OR，0.53；95%CI，0.40-0.70）。LE8 每增加 100 分，全因死亡率和心血管死亡率的多变量调整风险比（HR）分别为 0.71（95%CI，0.62-0.81）和 0.68（95%CI，0.58-0.85）。对于全因和心血管死亡率，LE8 水平处于中等到高水平的参与者也表现出类似的负相关模式。值得注意的是，在 60 岁以下的参与者中，LE8 与死亡率之间的关联更强（交互检验 P<0.05）。此外，LE8 与全因死亡率呈线性相关（非线性 P 值=0.32）。
AHA 新提出的 LE8 与 T2DM 患者 DR、全因死亡率和心血管特异性死亡率的风险呈强烈的负相关。LE8 可能是 T2DM 三级预防的一种可行且有效的方法。
