Department of Social Epidemiology Graduate School of Medicine Kyoto University Kyoto Japan.
Department of Preventive Services Kyoto University School of Public Health Kyoto Japan.
J Am Heart Assoc. 2024 Jul 2;13(13):e033860. doi: 10.1161/JAHA.123.033860. Epub 2024 Jun 27.
Although living alone versus with others is a key social element for cardiovascular prevention in diabetes, evidence is lacking about whether the benefit of intensive glycemic and blood pressure (BP) control differs by living arrangements. We thus aim to investigate heterogeneity in the joint effect of intensive glycemic and BP control on cardiovascular events by living arrangements among participants with diabetes.
This study included 4731 participants with diabetes in the ACCORD-BP (Action to Control Cardiovascular Risk in Diabetes-Blood Pressure) trial. They were randomized into 4 study arms, each with glycated hemoglobin target (intensive, <6.0% versus standard, 7.0-7.9%) and systolic BP target (intensive, <120 mm Hg versus standard <140 mm Hg). Cox proportional hazard models were used to estimate the joint effect of intensive glycemic and BP control on the composite cardiovascular outcome according to living arrangements. At a mean follow-up of 4.7 years, the cardiovascular outcome was observed in 445 (9.4%) participants. Among participants living with others, intensive treatment for both glycemia and BP showed decreased risk of cardiovascular events compared with standard treatment (hazard ratio [HR], 0.68 [95% CI, 0.51-0.92]). However, this association was not found among participants living alone (HR, 0.96 [95% CI, 0.58-1.59]). for interaction between intensive glycemic and BP control was 0.53 among participants living with others and 0.009 among those living alone ( value for 3-way interaction including living arrangements was 0.049).
We found benefits of combining intensive glycemic and BP control for cardiovascular outcomes among participants living with others but not among those living alone. Our study highlights the critical role of living arrangements in intensive care among patients with diabetes.
尽管独居或与他人同住是糖尿病心血管预防的一个关键社会因素，但目前缺乏关于强化血糖和血压（BP）控制对不同居住安排的心血管结局影响是否存在差异的证据。因此，我们旨在研究在糖尿病患者中，根据居住安排，强化血糖和 BP 控制对心血管事件的联合作用是否存在异质性。
这项研究纳入了 ACCORD-BP（控制糖尿病心血管风险行动-血压）试验中的 4731 名糖尿病患者。他们被随机分配到 4 个研究组，每组的糖化血红蛋白目标（强化组，<6.0%；标准组，7.0-7.9%）和收缩压目标（强化组，<120mmHg；标准组，<140mmHg）不同。采用 Cox 比例风险模型根据居住安排估计强化血糖和 BP 控制对复合心血管结局的联合作用。平均随访 4.7 年后，445 名（9.4%）参与者发生心血管结局。在与他人同住的参与者中，与标准治疗相比，强化血糖和 BP 治疗可降低心血管事件风险（风险比[HR]，0.68[95%可信区间，0.51-0.92]）。然而，在独居的参与者中，这种关联并不存在（HR，0.96[95%可信区间，0.58-1.59]）。对于与他人同住的参与者，强化血糖和 BP 控制之间的交互作用检验值为 0.53，而独居的参与者则为 0.009（包括居住安排的 3 项交互作用检验值为 0.049）。
我们发现，对于与他人同住的参与者，联合强化血糖和 BP 控制对心血管结局有益，但对于独居的参与者则无此获益。我们的研究强调了居住安排在糖尿病患者强化治疗中的关键作用。
