Ideal Cardiovascular Health Metrics and Major Cardiovascular Events in Patients With Prediabetes and Diabetes
Ideal Cardiovascular Health Metrics and Major Cardiovascular Events in Patients With Prediabetes and Diabetes
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DOI：
10.1001/jamacardio.2019.2499
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发表时间：
2019-09-01
期刊：
影响因子：
24
通讯作者：
Chen, Li
中科院分区：
文献类型：
--
作者：
Wang, Tiange;Lu, Jieli;Chen, Li
是否最佳的心血管健康指标可以抵消糖尿病前期或糖尿病患者心血管事件的风险尚不清楚。目的：与血糖调节正常的受试者相比，探讨糖尿病前期或糖尿病患者理想心血管健康指标（ICVHMs）与心血管疾病（CVD）后续发展的关系。设计、环境和参与者中国心脏代谢疾病和癌症队列研究是一项全国性、基于人群的前瞻性队列研究，研究对象包括来自中国不同地理区域的20个社区。该研究包括111765名参与者，他们在基线时没有心血管疾病或癌症。数据分析时间为2011年至2016年。糖尿病前期和糖尿病的定义是根据美国糖尿病协会2010年的标准。七个icvhm是根据美国心脏协会的建议改编的。致死性或非致死性CVD事件的综合，包括心血管死亡、心肌梗死、中风、住院或治疗的心力衰竭。结果在111765名参与者中，24881人（22.3%）血糖调节正常，61024人（54.6%）患有糖尿病前期，25860人（23.1%）患有糖尿病。平均（SD）年龄为52.9(8.6)~ 59.4（8.7）岁。与血糖调节正常的受试者相比，在糖尿病前期受试者中，1次ICVHM或更少的受试者CVD的多变量调整风险比为1.34 (95% CI, 1.16-1.55)，至少5次ICVHM的受试者CVD的多变量调整风险比为0.57 (95% CI, 0.43-0.75)；在糖尿病患者中，心血管疾病的风险比分别为2.05 （95% CI, 1.76-2.38）和0.80 (95% CI, 0.56-1.15)，分别为1个或更少的ICVHM和至少5个ICVHM。这样的模式ICVHMs和心血管疾病之间的联系更加突出了55岁以下的参加者(前驱糖尿病和至少5 ICVHMs:风险比[HR], 0.32; 95%可信区间,0.16 - -0.63,1 ICVHM或少:人力资源,1.58;95%可信区间,1.13 - -2.21;糖尿病和至少5 ICVHMs:人力资源,0.99;95%可信区间,0.44 - -2.26,1 ICVHM或少:人力资源,2.46;95%可信区间,1.71 - -3.54,而正常的葡萄糖调节)比参与者,65岁或更老的(前驱糖尿病和至少5 ICVHMs:人力资源,0.80;95%可信区间,0.50 - -1.26;1 ICVHM及以下：HR， 1.01；95% ci, 0.79-1.31；糖尿病和至少5例icvhm: HR， 0.79；95% ci, 0.46-1.35；1 ICVHM及以下：HR， 1.73；95% CI, 1.36-2.22，与正常血糖调节相比；相互作用的P值
IMPORTANCE Whether optimal cardiovascular health metrics may counteract the risk of cardiovascular events among patients with prediabetes or diabetes is unclear.OBJECTIVE To investigate the associations of ideal cardiovascular health metrics (ICVHMs) with subsequent development of cardiovascular disease (CVD) among participants with prediabetes or diabetes as compared with participants with normal glucose regulation.DESIGN, SETTING, AND PARTICIPANTS The China Cardiometabolic Disease and Cancer Cohort Study was a nationwide, population-based, prospective cohort study of 20 communities from various geographic regions in China. The study included 111765 participants who were free from CVD or cancer at baseline. Data were analyzed between 2011 and 2016.EXPOSURES Prediabetes and diabetes were defined according to the American Diabetes Association 2010 criteria. Seven ICVHMs were adapted from the American Heart Association recommendations.MAIN OUTCOMES AND MEASURES The composite of incident fatal or nonfatal CVD, including cardiovascular death, myocardial infarction, stroke, and hospitalized or treated heart failure.RESULTS Of the 111765 participants, 24881 (22.3%) had normal glucose regulation, 61024 (54.6%) had prediabetes, and 25860 (23.1%) had diabetes. Mean (SD) age ranged from 52.9 (8.6) years to 59.4 (8.7) years. Compared with participants with normal glucose regulation, among participants with prediabetes, the multivariable-adjusted hazard ratio for CVD was 1.34 (95% CI, 1.16-1.55) for participants who had 1 ICVHM or less and 0.57 (95% CI, 0.43-0.75) for participants who had at least 5 ICVHMs; among participants with diabetes, the hazard ratios for CVD were 2.05 (95% CI, 1.76-2.38) and 0.80 (95% CI, 0.56-1.15) for participants who had 1 ICVHM or less and at least 5 ICVHMs, respectively. Such pattern of association between ICVHMs and CVD was more prominent for participants younger than 55 years (prediabetes and at least 5 ICVHMs: hazard ratio [HR], 0.32; 95% CI, 0.16-0.63; 1 ICVHM or less: HR, 1.58; 95% CI, 1.13-2.21; diabetes and at least 5 ICVHMs: HR, 0.99; 95% CI, 0.44-2.26; 1 ICVHM or less: HR, 2.46; 95% CI, 1.71-3.54; compared with normal glucose regulation) than for participants 65 years or older (prediabetes and at least 5 ICVHMs: HR, 0.80; 95% CI, 0.50-1.26; 1 ICVHM or less: HR, 1.01; 95% CI, 0.79-1.31; diabetes and at least 5 ICVHMs: HR, 0.79; 95% CI, 0.46-1.35; 1 ICVHM or less: HR, 1.73; 95% CI, 1.36-2.22, compared with normal glucose regulation; P values for interaction