糖尿病、血糖控制与动脉僵硬度：在预测、预防和个性化医学背景下的一项真实世界队列研究
Diabetes, glycemic control and arterial stiffness: a real-world cohort study in the context of predictive, preventive, and personalized medicine.
作者信息
Cui Cancan, Zhang Te, Qi Yitian, Chu Jiaqi, Xu Haikun, Sun Chen, Zhang Zhenming, Wang Xingang, Yue Siqi, Kang Xiaoping, Fang Ling
机构信息
China-Japan Union Hospital of Jilin University, Jilin University, Changchun, China.
School of Medical Imaging, Dalian Medical University, Dalian, China.
出版信息
EPMA J. 2023 Nov 24;14(4):663-672. doi: 10.1007/s13167-023-00347-z. eCollection 2023 Dec.
BACKGROUND
Arterial stiffness is a major contributor to morbidity and mortality worldwide. Although several metabolic markers associated with arterial stiffness have been developed, there is limited data regarding whether glycemic control modifies the association between diabetes and arterial stiffness. For these reasons, identification of traits around diabetes will directly contribute to arterial stiffness and atherosclerosis management in the context of predictive, preventive, and personalized medicine (PPPM). Thus, this study aimed to explore the relationship of diabetes and glycemic control status with arterial stiffness in a real-world setting.
METHODS
Data of participants from Beijing Xiaotangshan Examination Center (BXEC) with at least two surveys between 2008 and 2019 were used. Cumulative hazards were presented by inverse probability of treatment weighted (IPTW) Kaplan-Meier curves. Cox models were used to estimate the hazard ratio (HR) and 95% confidence interval (CI). Arterial stiffness was defined as brachial-ankle pulse wave velocity (baPWV) ≥1400 cm/s.
RESULTS
Of 5837 participants, the mean baseline age was 46.5±9.3 years, including 3791 (64.9%) males. During a median follow-up of 4.0 years, 1928 (33.0%) cases of incident arterial stiffness were observed. People with diabetes at baseline had a 48.4% (HR: 1.484, 95% CI: 1.250-1.761) excessive risk of arterial stiffness. Adherence to good glycemic control attenuated the relationship between diabetes and arterial stiffness (HR: 1.264, 95% CI: 0.950-1.681); while uncontrolled diabetes was associated with the highest risk of arterial stiffness (HR: 1.629, 95% CI: 1.323-2.005). Results were consistent using IPTW algorithm and multiple imputed data.
CONCLUSION
Our study quantified that diabetes status is closely associated with an increased risk of arterial stiffness and supported that adherence to good glycemic control could attenuate the adverse effect of diabetes on arterial stiffness. Therefore, glucose monitoring and control is a cost-effective strategy for the predictive diagnostics, targeted prevention, patient stratification, and personalization of medical services in early vascular damages and arterial stiffness.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s13167-023-00347-z.
背景
动脉僵硬度是全球发病率和死亡率的主要促成因素。尽管已经开发了几种与动脉僵硬度相关的代谢标志物，但关于血糖控制是否会改变糖尿病与动脉僵硬度之间的关联的数据有限。基于这些原因，在预测、预防和个性化医学（PPPM）的背景下，识别糖尿病相关特征将直接有助于动脉僵硬度和动脉粥样硬化的管理。因此，本研究旨在探讨现实环境中糖尿病和血糖控制状态与动脉僵硬度之间的关系。
方法
使用北京小汤山体检中心（BXEC）2008年至2019年间至少进行过两次调查的参与者数据。累积风险通过逆概率加权（IPTW）Kaplan-Meier曲线呈现。采用Cox模型估计风险比（HR）和95%置信区间（CI）。动脉僵硬度定义为臂踝脉搏波速度（baPWV）≥1400 cm/s。
结果
在5837名参与者中，平均基线年龄为46.5±9.3岁，其中男性3791名（64.9%）。在中位随访4.0年期间，观察到1928例（33.0%）新发动脉僵硬度病例。基线时患有糖尿病的人发生动脉僵硬度的风险高出48.4%（HR：1.484，95%CI：1.250-1.761）。坚持良好的血糖控制可减弱糖尿病与动脉僵硬度之间的关系（HR：1.264，95%CI：0.950-1.681）；而未控制的糖尿病与动脉僵硬度的最高风险相关（HR：1.629，`95%CI：1.323-2.005）。使用IPTW算法和多重填补数据得到的结果一致。
结论
我们的研究量化了糖尿病状态与动脉僵硬度风险增加密切相关，并支持坚持良好的血糖控制可减弱糖尿病对动脉僵硬度的不利影响。因此，血糖监测和控制是早期血管损伤和动脉僵硬度预测诊断、靶向预防、患者分层及医疗服务个性化的一种具有成本效益的策略。
补充信息
在线版本包含可在10.1007/s13167-023-00347-z获取的补充材料。
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