Li Chenglong, He Daijun, Liu Yufan, Yang Chao, Zhang Luxia, Pop-Busui Rodica
National Institute of Health Data Science at Peking University, Beijing 100191, PR China; Institute of Medical Technology, Health Science Center of Peking University, Beijing 100191, PR China.
Renal Division, Department of Medicine, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, PR China; Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China; and Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, PR China; Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, PR China.
J Prev Alzheimers Dis. 2025 Mar;12(3):100047. doi: 10.1016/j.tjpad.2024.100047. Epub 2025 Jan 13.
Atrial fibrillation (AF) has been associated with elevated dementia risk, while few studies have examined the role of the optimal glycemic status in disease trajectories of AF and dementia.
We aim to evaluate associations between glycemic status with disease trajectories of AF and dementia, as well as major dementia subtypes, including Alzheimer's disease and vascular dementia.
Population-based cohort study.
UK Biobank.
A total of 458 368 participants who were free of prevalent dementia and AF at baseline, with complete glycemic status assessment.
Based on clinical recommendations, we categorized glycemic status as low-normal (glycated hemoglobin [HbA1c] <5.5 %), normal (HbA1c 5.5 to 5.9 %), pre-diabetes (HbA1c 6.0 to 6.4 %), diabetes with HbA1c<7 %, and diabetes with HbA1c≥7 %. Outcomes including AF, dementia (all-cause and sub-type dementia), and death were ascertained via linkage to external registry databases. A multi-state survival analysis was conducted to evaluate disease trajectories of AF and dementia.
Better glycemic status was consistently associated with decreased hazards of trajectories of AF and dementia, including progression from AF to the comorbidity of AF and dementia. Among people with diabetes, those with HbA1c<7 % had a 31 % lower hazard (hazard ratio [HR], 0.69; 95 % confidence intervals [CI], 0.51-0.93) of progression from incident AF to dementia comorbidity, compared to those with HbA1c≥7 %. Similar risk reductions were found in individuals with pre-diabetes, normal HbA1c, and low-normal HbA1c, respectively. Strong dose-response associations were observed, with each 1 % increment in HbA1c related to a 28 % higher hazard of progression from AF to dementia comorbidity (HR,1.28; 95 % CI, 1.19-1.37). The glycemic status was most relevant for associations with disease trajectories of AF and vascular dementia, compared to trajectories of AF and Alzheimer's disease.
The better glycemic status was consistently associated with lower hazards of disease trajectories of AF and dementia, including the reduced risk of progression from incident AF to comorbidity of AF and dementia. These findings support the significance of reaching optimal glycemic status to alleviate the huge disease burden of both AF and dementia simultaneously.
房颤（AF）与痴呆风险升高相关，而很少有研究探讨最佳血糖状态在房颤和痴呆疾病发展轨迹中的作用。
我们旨在评估血糖状态与房颤和痴呆疾病发展轨迹以及主要痴呆亚型（包括阿尔茨海默病和血管性痴呆）之间的关联。
基于人群的队列研究。
英国生物银行。
共有458368名参与者，他们在基线时无痴呆和房颤，且血糖状态评估完整。
根据临床建议，我们将血糖状态分为低正常（糖化血红蛋白[HbA1c]<5.5%）、正常（HbA1c 5.5至5.9%）、糖尿病前期（HbA1c 6.0至6.4%）、HbA1c<7%的糖尿病和HbA1c≥7%的糖尿病。通过与外部登记数据库的链接确定包括房颤、痴呆（全因和亚型痴呆）和死亡在内的结局。进行多状态生存分析以评估房颤和痴呆的疾病发展轨迹。
更好的血糖状态始终与房颤和痴呆疾病发展轨迹的风险降低相关，包括从房颤进展到房颤合并痴呆。在糖尿病患者中，与HbA1c≥7%的患者相比，HbA1c<7%的患者从新发房颤进展到痴呆合并症的风险降低31%（风险比[HR]，0.69；95%置信区间[CI]，0.51 - 0.93）。在糖尿病前期、HbA1c正常和低正常的个体中也分别发现了类似的风险降低。观察到强烈的剂量反应关联，HbA1c每增加1%，从房颤进展到痴呆合并症的风险就高28%（HR，1.28；95% CI，1.19 - 1.37）。与房颤和阿尔茨海默病的疾病发展轨迹相比，血糖状态与房颤和血管性痴呆的疾病发展轨迹的关联最为显著。
更好的血糖状态始终与房颤和痴呆疾病发展轨迹的风险降低相关，包括从新发房颤进展到房颤合并痴呆的风险降低。这些发现支持达到最佳血糖状态对于同时减轻房颤和痴呆巨大疾病负担的重要性。
