Relationship between HbA1c levels and risk of cardiovascular adverse outcomes and all-cause mortality in overweight and obese cardiovascular high-risk women and men with type 2 diabetes
Relationship between HbA1c levels and risk of cardiovascular adverse outcomes and all-cause mortality in overweight and obese cardiovascular high-risk women and men with type 2 diabetes
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DOI：
10.1007/s00125-012-2584-3
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发表时间：
2012-09-01
期刊：
影响因子：
8.2
通讯作者：
Torp-Pedersen, C.
中科院分区：
文献类型：
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作者：
Andersson, C.;van Gaal, L.;Torp-Pedersen, C.
预防肥胖心血管高危2型糖尿病患者大血管并发症和死亡的最佳HbA（1c）浓度仍有待确定，因此在西布曲明心血管结局（SCOUT）试验的事后分析中进行了研究，该试验招募了超重和肥胖2型糖尿病和/或心血管疾病患者。使用考克斯回归模型分析非致死性心肌梗死、非致死性卒中、复苏后心脏骤停或心血管死亡的发生率和全因死亡率。在SCOUT纳入的8，252例2型糖尿病患者中，7，479例在基线（即研究随机化）时可获得HbA（1c）测量值。中位年龄为62岁（范围51-86岁），中位BMI为34.0 kg/m2（24.8-65.1 kg/m2），44%为女性。HbA（1c）浓度中位数为7.2%（3.8-15.9%）（55 mmol/l [18-150 mmol/l]），糖尿病病程中位数为7年（0-57年）。HbA（1c）每增加1个百分点，主要终点的校正HR为1.17（95% CI 1.11，1.23）;未观察到性别差异效应（相互作用p = 0.12）。相比之下，女性的全因死亡风险高于男性：HbA（1c）每增加1个百分点，HR为1.22（1.10，1.34）vs 1.12（1.04，1.20）（相互作用p = 0.02）。没有证据表明与HbA（1c）a千分之一货币符号6.4%（a千分之一货币符号46 mmol/l）相关的风险增加。降糖治疗方案、糖尿病病程或心血管疾病史并不能改变相关性。在超重、心血管高危的2型糖尿病患者中，HbA（1c）浓度升高与心血管不良结局和全因死亡率的风险增加相关。
The optimal HbA(1c) concentration for prevention of macrovascular complications and deaths in obese cardiovascular high-risk patients with type 2 diabetes remains to be established and was therefore studied in this post hoc analysis of the Sibutramine Cardiovascular OUTcomes (SCOUT) trial, which enrolled overweight and obese patients with type 2 diabetes and/or cardiovascular disease.HRs for meeting the primary endpoint (nonfatal myocardial infarction, nonfatal stroke, resuscitated cardiac arrest or cardiovascular death) and all-cause mortality were analysed using Cox regression models.Of 8,252 patients with type 2 diabetes included in SCOUT, 7,479 had measurements of HbA(1c) available at baseline (i.e. study randomisation). Median age was 62 years (range 51-86 years), median BMI was 34.0 kg/m(2) (24.8-65.1 kg/m(2)) and 44% were women. The median HbA(1c) concentration was 7.2% (3.8-15.9%) (55 mmol/l [18-150 mmol/l]) and median diabetes duration was 7 years (0-57 years). For each 1 percentage point HbA(1c) increase, the adjusted HR for the primary endpoint was 1.17 (95% CI 1.11, 1.23); no differential sex effect was observed (p = 0.12 for interaction). In contrast, the risk of all-cause mortality was found to be greater in women than in men: HR 1.22 (1.10, 1.34) vs 1.12 (1.04, 1.20) for each 1 percentage point HbA(1c) increase (p = 0.02 for interaction). There was no evidence of increased risk associated with HbA(1c) a parts per thousand currency sign6.4% (a parts per thousand currency sign46 mmol/l). Glucose-lowering treatment regimens, diabetes duration or a history of cardiovascular disease did not modify the associations.In overweight, cardiovascular high-risk patients with type 2 diabetes, increasing HbA(1c) concentrations were associated with increasing risks of cardiovascular adverse outcomes and all-cause mortality.