Risk of Cardiovascular Disease and Death in Individuals With Prediabetes Defined by Different Criteria: The Whitehall II Study
Risk of Cardiovascular Disease and Death in Individuals With Prediabetes Defined by Different Criteria: The Whitehall II Study
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DOI：
10.2337/dc17-2530
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发表时间：
2018-04-01
期刊：
影响因子：
16.2
通讯作者：
Faerch, Kristine
中科院分区：
文献类型：
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作者：
Vistisen, Dorte;Witte, Daniel R.;Faerch, Kristine
目的比较空腹血糖(FPG)、2小时血糖(2hPG)或糖化血红蛋白(1c)定义的糖尿病前期亚组的心血管疾病(CVD)风险和全因死亡率。研究设计与方法在WhiteHall II队列中，对5,427名年龄在50-79岁且无糖尿病的参与者进行了中位时间11.5年的跟踪调查。根据世界卫生组织(WHO)/国际专家委员会(IEC)的标准，共有628人(11.6%)患有糖尿病前期(FPG6.1-6.9 mmol/L和/或HbA(1c)6.0-6.4%)，根据美国糖尿病协会(ADA)的标准(FPG5.6-6.9 mmol/L和/或HbA(1c)5.7-6.4%)，共有1,996人(36.8%)患有糖尿病前期。在4730名额外测量2hPG的受试者中，663人(14.0%)在2hPG之前就有糖尿病前期。对糖尿病前期不同定义的重大事件(非致命性/致命性心血管疾病或全因死亡)的发生率进行了比较，并对相关因素进行了调整。结果与正常血糖相比，糖尿病前期的发生率在世界卫生组织/IEC定义下高54%，在ADA定义下高37%(P<；0.001)，但经混杂因素调整后降至17%和12%(P 0.111)。糖化血红蛋白(1c)的糖尿病前期与IEC和ADA标准的发病率翻倍相关。然而，经过调整后，超额风险分别降至13%和17%(P 0.055)。在调整后的分析中，空腹血糖或2hPG定义的糖尿病前期与额外风险无关。结论糖化血红蛋白(1c)定义的糖尿病前期比空腹血糖或2hPG定义的糖尿病前期预后更差。然而，糖尿病前期患者的额外风险主要是由与高血糖相关的其他心脏代谢危险因素的聚集所解释的。
OBJECTIVEWe compared the risk of cardiovascular disease (CVD) and all-cause mortality in subgroups of prediabetes defined by fasting plasma glucose (FPG), 2-h plasma glucose (2hPG), or HbA(1c).RESEARCH DESIGN AND METHODSIn the Whitehall II cohort, 5,427 participants aged 50-79 years and without diabetes were followed for a median of 11.5 years. A total of 628 (11.6%) had prediabetes by the World Health Organization (WHO)/International Expert Committee (IEC) criteria (FPG 6.1-6.9 mmol/L and/or HbA(1c) 6.0-6.4%), and 1,996 (36.8%) by the American Diabetes Association (ADA) criteria (FPG 5.6-6.9 mmol/L and/or HbA(1c) 5.7-6.4%). In a subset of 4,730 individuals with additional measures of 2hPG, 663 (14.0%) had prediabetes by 2hPG. Incidence rates of a major event (nonfatal/fatal CVD or all-cause mortality) were compared for different definitions of prediabetes, with adjustment for relevant confounders.RESULTSCompared with that for normoglycemia, incidence rate in the context of prediabetes was 54% higher with the WHO/IEC definition and 37% higher with the ADA definition (P < 0.001) but declining to 17% and 12% after confounder adjustment (P 0.111). Prediabetes by HbA(1c) was associated with a doubling in incidence rate for both the IEC and ADA criteria. However, upon adjustment, excess risk was reduced to 13% and 17% (P 0.055), respectively. Prediabetes by FPG or 2hPG was not associated with an excess risk in the adjusted analysis.CONCLUSIONSPrediabetes defined by HbA(1c) was associated with a worse prognosis than prediabetes defined by FPG or 2hPG. However, the excess risk among individuals with prediabetes is mainly explained by the clustering of other cardiometabolic risk factors associated with hyperglycemia.