Wang Yizhe, Duan Yu, Zhang Yongcheng, Li Na, Hu Ying, Gu Liping, Hou Yanfang, Ma Yuhang
University of Shanghai for Science and Technology, Shanghai, China.
Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Endocrinol (Lausanne). 2025 Aug 26;16:1609144. doi: 10.3389/fendo.2025.1609144. eCollection 2025.
To investigate the predictors influencing the advancement of 10-year cardiovascular disease (CVD) risk after infection with Corona Virus Disease 2019 (COVID-19) in type 2 diabetes patients, and to provide a theoretical basis for an early intervention program for the cardiovascular dimension of the cardiovascular-kidney-metabolic syndrome (CKM syndrome).
A cohort of 378 individuals diagnosed with type 2 diabetes was analyzed retrospectively. The progression of 10-year CVD risk was characterized by an elevation in the 10-year CVD risk category, as determined by the SCORE2-Diabetes scoring system, in type 2 diabetic infected with COVID-19. Factors influencing 10-year CVD risk progression were evaluated through univariate and multivariate stepwise logistic regression. Nonlinear relationships between predictors and 10-year CVD progression were assessed using restricted cubic spline (RCS) analysis, subsequently followed by an analysis of threshold effects. Finally, the predictive performance of various factor combinations for 10-year CVD risk progression during the post-acute COVID-19 phase in type 2 diabetes mellitus cohorts was measured by area under roc curve (AUC).
After infection with COVID-19, 12.2% (n=46) experienced progression in their 10-year CVD risk category. In multifactorial stepwise logistic regression, alcohol consumption [odds ratio (OR) 2.10, 95% confidence interval (CI) 1.02-4.34], estimated glomerular filtration rate (eGFR) (OR 0.96, 95% CI 0.94-0.99) and high-sensitivity C-reactive protein (hs-CRP) (OR 1.33, 95% CI 1.13-1.57), were found to be significantly linked to the progression of 10-year CVD risk. Restricted cubic spline analysis (RCS) demonstrated a nonlinear correlation between hs-CRP and 10-year CVD risk progression with a threshold of 3.0 mg/L. 10-year CVD risk was significantly higher with increasing hs-CRP levels at hs-CRP < 3.0 mg/L (OR 2.28, 95% CI 1.48-3.55), and the two-stage model significantly superior to a single linear model ( = 0.028 for log-likelihood ratio). Among the different combinations of models for alcohol consumption, hs-CRP, and eGFR, the full model combination of all three had the best predictive effect (AUC = 0.749).
Alcohol consumption and elevated hs-CRP were associated with increased cardiovascular risk progression, while higher eGFR levels were inversely associated with risk progression.
探讨2型糖尿病患者感染2019冠状病毒病（COVID-19）后影响10年心血管疾病（CVD）风险进展的预测因素，为心血管-肾脏-代谢综合征（CKM综合征）心血管维度的早期干预方案提供理论依据。
回顾性分析378例确诊为2型糖尿病的患者队列。10年CVD风险的进展以感染COVID-19的2型糖尿病患者中10年CVD风险类别升高为特征，由SCORE2-糖尿病评分系统确定。通过单因素和多因素逐步逻辑回归评估影响10年CVD风险进展的因素。使用受限立方样条（RCS）分析评估预测因素与10年CVD进展之间的非线性关系，随后进行阈值效应分析。最后，通过roc曲线下面积（AUC）测量2型糖尿病队列中急性COVID-19后阶段各种因素组合对10年CVD风险进展的预测性能。
感染COVID-19后，12.2%（n=46）的患者10年CVD风险类别有所进展。在多因素逐步逻辑回归中，饮酒[比值比（OR）2.10，95%置信区间（CI）1.02-4.34]、估算肾小球滤过率（eGFR）（OR 0.96，95%CI 0.94-0.99）和高敏C反应蛋白（hs-CRP）（OR 1.33，95%CI 1.13-1.57）与10年CVD风险进展显著相关。受限立方样条分析（RCS）显示hs-CRP与10年CVD风险进展之间存在非线性相关性，阈值为3.0mg/L。hs-CRP<3.0mg/L时，随着hs-CRP水平升高，10年CVD风险显著更高（OR 2.28，95%CI 1.48-3.55），两阶段模型显著优于单一线性模型（对数似然比 = 0.028）。在饮酒、hs-CRP和eGFR的不同模型组合中，三者的全模型组合预测效果最佳（AUC = 0.749）。
饮酒和hs-CRP升高与心血管风险进展增加相关，而较高的eGFR水平与风险进展呈负相关。
