Association between prediabetes and risk of cardiovascular disease and all cause mortality: systematic review and meta-analysis.
Association between prediabetes and risk of cardiovascular disease and all cause mortality: systematic review and meta-analysis.
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DOI：
10.1136/bmj.i5953
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发表时间：
2016-11-23
期刊：
影响因子：
--
通讯作者：
Hu Y
中科院分区：
文献类型：
--
作者：
Huang Y;Cai X;Mai W;Li M;Hu Y
目的评估糖尿病前期不同定义与心血管疾病风险和全因死亡率之间的关系。设计前瞻性队列研究的荟萃分析。数据来源电子数据库（PubMed、Embase和Google Scholar）。纳入荟萃分析的前瞻性队列研究来自一般人群，如果他们报告了复合心血管疾病、冠心病、卒中、全因死亡率和前驱糖尿病风险之间相关性的校正相对风险和95%置信区间。审查方法两名作者独立审查和选择合格的研究，根据预先确定的选择标准。根据美国糖尿病协会的标准，糖尿病前期被定义为空腹血糖受损（IFG-ADA;空腹血糖5.6-6.9 mmol/L），WHO专家组（IFG-WHO;空腹血糖6.1-6.9 mmol/L）、糖耐量受损（口服葡萄糖耐量试验期间2小时血糖浓度为7.8-11.0 mmol/L），或根据ADA标准，血红蛋白A1 c（HbA 1c）升高至39-47 mmol/mol（5.7-6.4%）或根据国家健康与护理卓越研究所（NICE）指南升高至42-47 mmol/mol（6.0-6.4%）。计算全因死亡率和心血管事件的相对风险，并报告95%置信区间。结果共纳入53篇前瞻性队列研究，纳入受试者1611339人。中位随访时间为9.5年。与正常血糖相比，糖尿病前期（根据IFG-ADA或IFG-WHO标准，糖耐量受损或空腹血糖受损）与复合心血管疾病的风险增加相关（IFG-ADA、IFG-WHO和糖耐量受损的相对风险分别为1.13、1.26和1.30）、冠心病（分别为1.10、1.18和1.20）、卒中（分别为1.06、1.17和1.20）和全因死亡率（分别为1.13、1.13和1.32）。HBA 1c升高至39-47 mmol/mol或42-47 mmol/mol均与复合心血管疾病（分别为1.21和1.25）和冠心病（分别为1.15和1.28）的风险增加相关，但与卒中和全因死亡率的风险增加无关。结论糖尿病前期（定义为糖耐量受损、空腹血糖受损或HbA 1c升高）与心血管疾病风险增加相关。空腹血糖浓度低至5.6 mmol/L或HbA 1c为39 mmol/mol的人群的健康风险可能会增加。
Objectives To evaluate associations between different definitions of prediabetes and the risk of cardiovascular disease and all cause mortality. Design Meta-analysis of prospective cohort studies. Data sources Electronic databases (PubMed, Embase, and Google Scholar). Selection criteria Prospective cohort studies from general populations were included for meta-analysis if they reported adjusted relative risks with 95% confidence intervals for associations between the risk of composite cardiovascular disease, coronary heart disease, stroke, all cause mortality, and prediabetes. Review methods Two authors independently reviewed and selected eligible studies, based on predetermined selection criteria. Prediabetes was defined as impaired fasting glucose according to the criteria of the American Diabetes Association (IFG-ADA; fasting glucose 5.6-6.9 mmol/L), the WHO expert group (IFG-WHO; fasting glucose 6.1-6.9 mmol/L), impaired glucose tolerance (2 hour plasma glucose concentration 7.8-11.0 mmol/L during an oral glucose tolerance test), or raised haemoglobin A1c (HbA1c) of 39-47 mmol/mol(5.7-6.4%) according to ADA criteria or 42-47 mmol/mol (6.0-6.4%) according to the National Institute for Health and Care Excellence (NICE) guideline. The relative risks of all cause mortality and cardiovascular events were calculated and reported with 95% confidence intervals. Results 53 prospective cohort studies with 1 611 339 individuals were included for analysis. The median follow-up duration was 9.5 years. Compared with normoglycaemia, prediabetes (impaired glucose tolerance or impaired fasting glucose according to IFG-ADA or IFG-WHO criteria) was associated with an increased risk of composite cardiovascular disease (relative risk 1.13, 1.26, and 1.30 for IFG-ADA, IFG-WHO, and impaired glucose tolerance, respectively), coronary heart disease (1.10, 1.18, and 1.20, respectively), stroke (1.06, 1.17, and 1.20, respectively), and all cause mortality (1.13, 1.13 and 1.32, respectively). Increases in HBA1c to 39-47 mmol/mol or 42-47 mmol/mol were both associated with an increased risk of composite cardiovascular disease (1.21 and 1.25, respectively) and coronary heart disease (1.15 and 1.28, respectively), but not with an increased risk of stroke and all cause mortality. Conclusions Prediabetes, defined as impaired glucose tolerance, impaired fasting glucose, or raised HbA1c, was associated with an increased risk of cardiovascular disease. The health risk might be increased in people with a fasting glucose concentration as low as 5.6 mmol/L or HbA1c of 39 mmol/mol.
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影响因子：
16.2
作者：
Bullard KM;Saydah SH;Imperatore G;Cowie CC;Gregg EW;Geiss LS;Cheng YJ;Rolka DB;Williams DE;Caspersen CJ
通讯作者：
Caspersen CJ
影响因子：
37.8
作者：
Hunt, KJ;Resendez, RG;Stern, MP
通讯作者：
Stern, MP
影响因子：
5.1
作者：
Hiltunen, L
通讯作者：
Hiltunen, L
影响因子：
6.7
作者：
Kaarisalo, Minna M.;Raiha, Ismo;Lehtonen, Aapo
通讯作者：
Lehtonen, Aapo
影响因子：
3.5
作者：
Deedwania, Prakash;Patel, Kanan;Ahmed, Ali
通讯作者：
Ahmed, Ali