糖化血红蛋白水平与不同年龄段糖尿病合并三支血管病变患者长期预后的关系：一项队列研究。

The association between glycated hemoglobin levels and long-term prognosis in patients with diabetes and triple-vessel coronary disease across different age groups: A cohort study.

机构信息

National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.

出版信息

Diabetes Res Clin Pract. 2024 Jul;213:111751. doi: 10.1016/j.diabres.2024.111751. Epub 2024 Jun 19.

DOI:10.1016/j.diabres.2024.111751

PMID:38906334

Abstract

AIM

Our study aimed to investigate the correlation between glycated hemoglobin (HbA1c) and adverse prognostic events in patients with diabetes and triple-vessel coronary disease (TVD).

METHODS

This study ultimately included 2051 patients with TVD and diabetes. Patients were categorized into five groups based on their HbA1c levels: < 6.0 %, 6.0-6.4 %, 6.5-6.9 %, 7.0-7.9 %, and ≥ 8.0 %. The primary endpoint was all-cause death, and the secondary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE).

RESULTS

The median follow-up time was 5.88 years. During this period, a total of 323 (15.7 %) all-cause deaths and 537 (26.2 %) MACCEs were recorded. The relationship between HbA1c and the risk of endpoint events showed a J-shaped pattern, with the lowest risk observed between 6.0 % and 6.4 %. Further analysis revealed a significant interaction between HbA1c and age. In the subgroup with age < 70 years, as HbA1c increased, the risk of endpoint events gradually rose. While in the subgroup with age ≥70 years, there was an L-shaped relationship between HbA1c and endpoint events, with the highest risk observed in patients with HbA1c < 6.0 %.

CONCLUSION

Our study revealed variations in the relationship between HbA1c levels and endpoint events among patients with TVD and diabetes of different ages. In younger patients, elevated HbA1c levels were associated with a higher risk of death and MACCE, while in older patients, excessively low HbA1c levels (HbA1c < 6 %) were linked to a higher risk of death and MACCE.

摘要

目的

本研究旨在探讨糖化血红蛋白（HbA1c）与糖尿病合并三血管病变（TVD）患者不良预后事件之间的相关性。

方法

本研究最终纳入 2051 例 TVD 合并糖尿病患者。根据 HbA1c 水平将患者分为五组：<6.0%、6.0-6.4%、6.5-6.9%、7.0-7.9%和≥8.0%。主要终点为全因死亡，次要终点为主要不良心血管和脑血管事件（MACCE）。

结果

中位随访时间为 5.88 年。在此期间，共发生 323 例（15.7%）全因死亡和 537 例（26.2%）MACCE。HbA1c 与终点事件风险之间的关系呈 J 形，6.0-6.4%之间风险最低。进一步分析显示，HbA1c 与年龄之间存在显著交互作用。在年龄<70 岁的亚组中，随着 HbA1c 的升高，终点事件的风险逐渐增加。而在年龄≥70 岁的亚组中，HbA1c 与终点事件之间呈 L 形关系，HbA1c<6.0%的患者风险最高。