Park Junhee, Han Kyungdo, Lee Kyuna, Chang Yoosoo, Shin Dong Wook
Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea.
Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, Republic of Korea.
Healthcare (Basel). 2025 Apr 2;13(7):796. doi: 10.3390/healthcare13070796.
Cardiovascular disease (CVD) risk may be based on the sequence of hypertension (HTN) and diabetes mellitus (DM) occurrence since the pathophysiological mechanisms might not be the same. The present study examined the risk of CVD according to the precedent relationship between HTN and DM. Participants with both HTN and DM in a national health screening program in 2015-2016 were divided into two groups based on the order of HTN and DM occurrence: 'HTN → DM' and 'DM → HTN'. The primary outcomes were newly diagnosed myocardial infarction (MI) and ischemic stroke based on the International Classification of Diseases, 10th revision code. Among 914,338 participants, there were 28,368 MI events and 35,632 ischemic stroke events during the follow-up period. The DM → HTN group showed a higher risk of MI (adjusted hazard ratio [aHR]: 1.13 [95% CI: 1.10-1.15]) and ischemic stroke (aHR: 1.06 [95% CI: 1.04-1.09]) than the HTN → DM group. The increased risk of MI in the DM → HTN group was more prominent in females than in males and in those without dyslipidemia than in those with dyslipidemia. A higher risk of MI and ischemic stroke in the DM-HTN group was found in patients with chronic kidney disease (CKD) than in patients without CKD. MI and ischemic stroke were more frequent in patients in the DM → HTN group than in those of the HTN → DM group. When approaching HTN and DM clinically and epidemiologically, two phenotypes based on the order of occurrence should be considered. Given the generalization limitations of Asian patients, who develop DM at an early age compared to other groups, future studies are needed to reveal the underlying mechanism in the precedence relationship between HTN and DM.
心血管疾病（CVD）风险可能取决于高血压（HTN）和糖尿病（DM）发生的先后顺序，因为其病理生理机制可能不尽相同。本研究根据HTN和DM的先后关系，对CVD风险进行了研究。在2015 - 2016年全国健康筛查项目中同时患有HTN和DM的参与者，根据HTN和DM发生的顺序分为两组：“HTN→DM”组和“DM→HTN”组。主要结局是基于国际疾病分类第10版编码新诊断的心肌梗死（MI）和缺血性卒中。在914,338名参与者中，随访期间有28,368例MI事件和35,632例缺血性卒中事件。“DM→HTN”组发生MI（调整后风险比[aHR]：1.13 [95%置信区间：1.10 - 1.15]）和缺血性卒中（aHR：1.06 [95%置信区间：1.04 - 1.09]）的风险高于“HTN→DM”组。“DM→HTN”组MI风险增加在女性中比男性更显著，在无血脂异常者中比有血脂异常者更显著。慢性肾脏病（CKD）患者中，“DM→HTN”组发生MI和缺血性卒中的风险高于无CKD患者。“DM→HTN”组患者发生MI和缺血性卒中的频率高于“HTN→DM”组患者。在临床和流行病学上处理HTN和DM时，应考虑基于发生顺序的两种表型。鉴于与其他群体相比，亚洲患者发病年龄较早，存在一定的普遍性局限，未来需要开展研究以揭示HTN和DM先后关系背后的潜在机制。
