血糖谱范围内心血管疾病的性别特异性风险：一项基于英国生物银行的人群队列研究。
Sex-specific risks for cardiovascular disease across the glycaemic spectrum: a population-based cohort study using the UK Biobank.
作者信息
Rentsch Christopher T, Garfield Victoria, Mathur Rohini, Eastwood Sophie V, Smeeth Liam, Chaturvedi Nish, Bhaskaran Krishnan
机构信息
Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06510, USA.
出版信息
Lancet Reg Health Eur. 2023 Aug 10;32:100693. doi: 10.1016/j.lanepe.2023.100693. eCollection 2023 Sep.
BACKGROUND
We sought to examine sex-specific risks for incident cardiovascular disease (CVD) across the full glycaemic spectrum.
METHODS
Using data from UK Biobank, we categorised participants' glycated haemoglobin (HbA1c) at baseline as low-normal (<35 mmol/mol), normal (35-41 mmol/mol), pre-diabetes (42-47 mmol/mol), undiagnosed diabetes (≥48 mmol/mol), or diagnosed diabetes. Our outcomes were coronary artery disease (CAD), atrial fibrillation, deep vein thrombosis (DVT), pulmonary embolism (PE), stroke, heart failure, and a composite outcome of any CVD. Cox regression estimated sex-specific associations between HbA1c and each outcome, sequentially adjusting for socio-demographic, lifestyle, and clinical characteristics.
FINDINGS
Among 427,435 people, CVD rates were 16.9 and 9.1 events/1000 person-years for men and women, respectively. Both men and women with pre-diabetes, undiagnosed diabetes, and, more markedly, diagnosed diabetes were at higher risks of CVD than those with normal HbA1c, with relative increases more pronounced in women than men. Age-adjusted HRs for pre-diabetes and undiagnosed diabetes ranged from 1.30 to 1.47; HRs for diagnosed diabetes were 1.55 (1.49-1.61) in men and 2.00 (1.89-2.12) in women (p-interaction <0.0001). Excess risks attenuated and were more similar between men and women after adjusting for clinical and lifestyle factors particularly obesity and antihypertensive or statin use (fully adjusted HRs for diagnosed diabetes: 1.06 [1.02-1.11] and 1.17 [1.10-1.24], respectively).
INTERPRETATION
Excess risks in men and women were largely explained by modifiable factors, and could be ameliorated by attention to weight reduction strategies and greater use of antihypertensive and statin medications. Addressing these risk factors could reduce sex disparities in risk of CVD among people with and without diabetes.
FUNDING
Diabetes UK (#15/0005250) and British Heart Foundation (SP/16/6/32726).
背景
我们试图研究整个血糖范围内心血管疾病（CVD）的性别特异性风险。
方法
利用英国生物银行的数据，我们将参与者基线时的糖化血红蛋白（HbA1c）分类为低正常（<35 mmol/mol）、正常（35 - 41 mmol/mol）、糖尿病前期（42 - 47 mmol/mol）、未确诊糖尿病（≥48 mmol/mol）或已确诊糖尿病。我们的结局包括冠状动脉疾病（CAD）、心房颤动、深静脉血栓形成（DVT）、肺栓塞（PE）、中风、心力衰竭以及任何心血管疾病的综合结局。Cox回归估计了HbA1c与每个结局之间的性别特异性关联，并依次对社会人口统计学、生活方式和临床特征进行了调整。
研究结果
在427,435人中，男性和女性的心血管疾病发生率分别为16.9和9.1例/1000人年。糖尿病前期、未确诊糖尿病以及更明显的已确诊糖尿病的男性和女性患心血管疾病的风险均高于HbA1c正常者，女性的相对增加比男性更明显。糖尿病前期和未确诊糖尿病的年龄调整后风险比范围为1.30至1.47；已确诊糖尿病的风险比在男性中为1.55（1.49 - 1.61），在女性中为2.00（1.89 - 2.12）（p交互作用<0.0001）。在调整临床和生活方式因素（特别是肥胖以及使用抗高血压药或他汀类药物）后，额外风险减弱，男性和女性之间更为相似（已确诊糖尿病的完全调整后风险比分别为1.06 [1.02 - 1.11]和1.17 [1.10 - 1.24]）。
解读
男性和女性的额外风险在很大程度上可由可改变因素解释，通过关注体重减轻策略以及更多地使用抗高血压药和他汀类药物可改善这些风险。解决这些风险因素可减少糖尿病患者和非糖尿病患者心血管疾病风险的性别差异。
资助
英国糖尿病协会（#15/0005250）和英国心脏基金会（SP/16/6/32726）。
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