身体虚弱与传统心血管危险因素控制对糖尿病患者心血管疾病的联合影响。

Joint effects of physical frailty and traditional cardiovascular risk factor control on cardiovascular disease in patients with diabetes.

机构信息

Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011 China.

出版信息

J Nutr Health Aging. 2024 Oct;28(10):100342. doi: 10.1016/j.jnha.2024.100342. Epub 2024 Aug 23.

DOI:10.1016/j.jnha.2024.100342

PMID:39180942

Abstract

OBJECTIVES

Physical frailty has been found to increase the risk of multiple adverse outcomes including cardiovascular disease (CVD) in diabetic patients, but whether this could be modified by traditional risk factor control remains unknown. We aimed to explore the joint and interaction effects of frailty and traditional risk factor control on the risk of CVD.

DESIGN

A population-based cohort study.

SETTING AND PARTICIPANTS

We included 15,753 participants with type 2 diabetes at baseline from UK Biobank.

MEASUREMENTS

Physical frailty was assessed by Fried criteria's frailty phenotype. The degree of risk factor control was determined by the numbers of the following factors controlled within the target range, including glycated hemoglobin, blood pressure, low-density lipoprotein cholesterol, smoking, and kidney condition. Incident CVD included coronary heart disease, stroke, or heart failure. Cox proportional hazard models were used to assess the individual and joint effects of frailty and risk factor control on the risk of CVD.

RESULTS

After a median follow-up of 13.5 years, 1129 incident CVD events were observed. Compared with non-frailty, both prefrailty and frailty were significantly associated with increased risk of CVD (HR 1.22, 95% CI [1.13, 1.31] for pre-frailty and 1.70 [1.53, 1.90] for frailty). For the joint effects, participants with frailty and a low degree of risk factor control (control of 0-1 risk factors) had the highest risk of CVD (2.92 [2.04, 4.17]) compared to those with non-frailty and optimal risk factor control (control of 4-5 risk factors). Moreover, a significant additive interaction between frailty and risk factor control was observed, with around 3.8% of CVD risk attributed to the interactive effects.

CONCLUSIONS

Both prefrailty and frailty were associated with a higher risk of CVD in participants with type 2 diabetes. Moreover, physical frailty could interact with the degree of risk factor control in an additive manner to increase the CVD risk.

摘要

目的

衰弱与多种不良结局相关，包括糖尿病患者的心血管疾病（CVD），但传统危险因素控制是否可以改变这种情况尚不清楚。本研究旨在探讨衰弱和传统危险因素控制对 CVD 风险的联合和交互作用。

设计

基于人群的队列研究。

地点和参与者

我们纳入了英国生物库中基线时患有 2 型糖尿病的 15753 名参与者。

测量方法

采用 Fried 标准的衰弱表型评估身体衰弱。危险因素控制程度通过控制在目标范围内的以下因素的数量来确定，包括糖化血红蛋白、血压、低密度脂蛋白胆固醇、吸烟和肾脏状况。CVD 事件包括冠心病、卒中和心力衰竭。采用 Cox 比例风险模型评估衰弱和危险因素控制对 CVD 风险的单独和联合作用。

结果

中位随访 13.5 年后，共发生 1129 例 CVD 事件。与非衰弱相比，衰弱前期和衰弱均与 CVD 风险增加显著相关（衰弱前期 HR 为 1.22，95%CI [1.13, 1.31]，衰弱 HR 为 1.70 [1.53, 1.90]）。对于联合作用，衰弱且危险因素控制程度低（控制 0-1 个危险因素）的患者发生 CVD 的风险最高（2.92 [2.04, 4.17]），与非衰弱且最佳危险因素控制（控制 4-5 个危险因素）的患者相比。此外，还观察到衰弱和危险因素控制之间存在显著的相加交互作用，大约 3.8%的 CVD 风险归因于交互作用。