Association between prediabetes and risk of all cause mortality and cardiovascular disease: updated meta-analysis
Association between prediabetes and risk of all cause mortality and cardiovascular disease: updated meta-analysis
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DOI：
10.1136/bmi.m2297
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发表时间：
2020-07-15
影响因子：
105.7
通讯作者：
Huang, Yuli
中科院分区：
文献类型：
--
作者：
Cai, Xiaoyan;Zhang, Yunlong;Huang, Yuli
目的评价糖尿病前期与普通人群和有动脉粥样硬化性心血管疾病史患者的全因死亡率和心血管疾病发病风险之间的关系。设计更新的荟萃分析。数据来源电子数据库（PubMed，Embase，（Google Scholar）回顾方法前瞻性队列研究或临床试验的事后分析，如果它们报告了调整后的与正常血糖相比，糖尿病前期的全因死亡率或心血管疾病的相对风险、比值比或危险比。数据由两名研究者独立提取。随机效应模型用于计算相对风险和95%置信区间。主要结局是全因死亡率和复合心血管疾病。结果共纳入129篇研究，涉及10 069 955例受试者。在一般人群中，糖尿病前期与全因死亡风险增加相关（相对风险1.13，95%置信区间1.10 - 1.17），复合心血管疾病（1.15，1.11至1.18），冠心病（1.16，1.11至1.21）和中风（1.14，1.08至1.20），中位随访时间为9.8年。与血糖正常者相比，糖尿病前期患者全因死亡率、复合心血管疾病、冠心病和卒中的绝对风险差异为7.36（95%置信区间9.59 - 12.51）、8.75（6.41 - 10.49）、6.59（4.53 - 8.65）和3.68（2.10 - 5.26）/10000人年。与空腹血糖受损相比，糖耐量受损者的全因死亡率、冠心病和中风风险更高。在动脉粥样硬化性心血管疾病患者中，糖尿病前期与全因死亡风险增加相关（相对风险1.36，95%置信区间1.21 - 1.54），复合心血管疾病中位随访时间为3.2年，其中冠心病（1.15，1.02至1.29）和中风（1.05，0.81至1.36）的风险无差异。动脉粥样硬化性心血管疾病患者中，糖尿病前期与正常血糖患者相比，全因死亡率、复合心血管疾病、冠心病和卒中的绝对风险差异为66.19（95%置信区间38.60 ~ 99.25）、189.77（117.97 ~ 271.84）、40.62（5.42 ~ 78.53）和8.54（32.43 ~ 61.45）/10000人年。不同定义的糖尿病前期患者发生心血管疾病的风险差异无统计学意义（均P>0.10）。结论糖尿病前期患者发生心血管疾病和全因死亡的风险增加。糖尿病前期的筛查和适当的管理可能有助于心血管疾病的一级和二级预防。
Objective To evaluate the associations between prediabetes and the risk of all cause mortality and incident cardiovascular disease in the general population and in patients with a history of atherosclerotic cardiovascular disease.Design Updated meta-analysis.Data sources Electronic databases (PubMed, Embase, and Google Scholar) up to 25 April 2020.Review methods Prospective cohort studies or post hoc analysis of clinical trials were included for analysis if they reported adjusted relative risks, odds ratios, or hazard ratios of all cause mortality or cardiovascular disease for prediabetes compared with normoglycaemia. Data were extracted independently by two investigators. Random effects models were used to calculate the relative risks and 95% confidence intervals. The primary outcomes were all cause mortality and composite cardiovascular disease. The secondary outcomes were the risk of coronary heart disease and stroke.Results A total of 129 studies were included, involving 10 069 955 individuals for analysis. In the general population, prediabetes was associated with an increased risk of all cause mortality (relative risk 1.13, 95% confidence interval 1.10 to 1.17), composite cardiovascular disease (1.15, 1.11 to 1.18), coronary heart disease (1.16, 1.11 to 1.21), and stroke (1.14, 1.08 to 1.20) in a median follow-up time of 9.8 years. Compared with normoglycaemia, the absolute risk difference in prediabetes for all cause mortality, composite cardiovascular disease, coronary heart disease, and stroke was 7.36 (95% confidence interval 9.59 to 12.51), 8.75 (6.41 to 10.49), 6.59 (4.53 to 8.65), and 3.68 (2.10 to 5.26) per 10 000 person years, respectively. Impaired glucose tolerance carried a higher risk of all cause mortality, coronary heart disease, and stroke than impaired fasting glucose. In patients with atherosclerotic cardiovascular disease, prediabetes was associated with an increased risk of all cause mortality (relative risk 1.36, 95% confidence interval 1.21 to 1.54), composite cardiovascular disease (1.37, 1.23 to 1.53), and coronary heart disease (1.15, 1.02 to 1.29) in a median follow-up time of 3.2 years, but no difference was seen for the risk of stroke (1.05, 0.81 to 1.36). Compared with normoglycaemia, in patients with atherosclerotic cardiovascular disease, the absolute risk difference in prediabetes for all cause mortality, composite cardiovascular disease, coronary heart disease, and stroke was 66.19 (95% confidence interval 38.60 to 99.25), 189.77 (117.97 to 271.84), 40.62 (5.42 to 78.53), and 8.54 (32.43 to 61.45) per 10 000 person years, respectively. No significant heterogeneity was found for the risk of all outcomes seen for the different definitions of prediabetes in patients with atherosclerotic cardiovascular disease (all P>0.10).Conclusions Results indicated that prediabetes was associated with an increased risk of all cause mortality and cardiovascular disease in the general population and in patients with atherosclerotic cardiovascular disease. Screening and appropriate management of prediabetes might contribute to primary and secondary prevention of cardiovascular disease.