Glycated hemoglobin and risk of stroke in people without known diabetes in the European Prospective Investigation into Cancer (EPIC)-Norfolk prospective population study - A threshold relationship?
Glycated hemoglobin and risk of stroke in people without known diabetes in the European Prospective Investigation into Cancer (EPIC)-Norfolk prospective population study - A threshold relationship?
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DOI：
10.1161/01.str.0000254549.75763.5f
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发表时间：
2007-02-01
期刊：
影响因子：
8.3
通讯作者：
Khaw, Kay-Tee
中科院分区：
文献类型：
--
作者：
Myint, Phyo K.;Sinha, Shubhada;Khaw, Kay-Tee
背景和目的-糖尿病是一个公认的心血管疾病的危险因素。有证据表明，血糖和心肌梗死之间存在线性关系，即使血糖浓度低于糖尿病阈值。血糖浓度和中风之间的关系，没有建立糖尿病的人已经研究得不太广泛。方法：我们在诺福克的欧洲癌症前瞻性研究（EPIC）中，在基线评估时，在无糖尿病和卒中的一般人群中，研究了通过糖化血红蛋白（HbA（1c））浓度测量的日常血糖水平与卒中发生风险之间的前瞻性关系。结果-共有10489名年龄在40 - 79岁的男性和女性接受了随访（平均=8.5年）。随着HbA 1c浓度的增加，平均年龄、收缩压和舒张压、体重指数、总胆固醇、甘油三酯和当前吸烟者比例增加，平均高密度脂蛋白胆固醇降低。在88652人-年中确定了164例中风事件。校正年龄、性别和心血管危险因素后，HbA 1c浓度为5%-5.4%、5.5%-6.9%和>= 7%的受试者发生卒中的相对风险（95%CI）为0.78与HbA（1c）<5%的患者相比，HbA（1c）水平分别为0.50 ~ 1.22、0.83（0.54 ~ 1.27）、2.83（1.40 ~ 5.74）。结论：与观察到的血糖水平和冠心病风险之间的连续线性关系相反，血糖水平和卒中风险之间的关联似乎更符合阈值关系。这些观察结果可能有助于了解不同血管疾病的不同发病机制。（中风。2007;38：271-275）。
Background and Purpose-Diabetes is a well-recognized risk factor for cardiovascular diseases. Evidence suggests a linear relationship between blood glucose and myocardial infarction, even at blood glucose concentrations below the threshold for diabetes. The relationship between blood glucose concentration and stroke in people without established diabetes has been studied less extensively. Methods-We examined the prospective relationship between usual blood glucose level measured by glycohemoglobin (HbA(1c)) concentrations and incident stroke risk in a general population without diabetes and stroke at baseline assessment in the European Prospective Investigation Into Cancer (EPIC)-Norfolk. Results-A total of 10 489 men and women aged 40 to 79 years at baseline were followed up ( mean=8.5 years). Mean age, systolic and diastolic blood pressure, body mass index, total cholesterol, triglycerides, and proportion of current smokers increased and mean high-density lipoprotein cholesterol decreased with increasing HbA1c concentrations. There were 164 incident strokes identified over 88 652 person-years. After adjustment for age, sex, and cardiovascular risk factors, the relative risks (95% CI) for stroke for participants with HbA(1c) concentrations 5% to 5.4%, 5.5% to 6.9%, and >= 7% were 0.78 (0.50 to 1.22), 0.83 (0.54 to 1.27), and 2.83 (1.40 to 5.74), respectively, compared with those with HbA(1c) < 5%. Conclusions-In contrast to the continuous linear relationship observed between blood glucose level and coronary heart disease risk, the association between blood glucose level and stroke risk appears to be more consistent with a threshold relationship. These observations may give insights into the differing pathogenesis of different vascular diseases. (Stroke. 2007;38:271-275.)