Meta-analysis: Glycosylated hemoglobin and cardiovascular disease in diabetes mellitus
Meta-analysis: Glycosylated hemoglobin and cardiovascular disease in diabetes mellitus
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DOI：
10.7326/0003-4819-141-6-200409210-00007
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发表时间：
2004-09-21
影响因子：
39.2
通讯作者：
Golden, SH
中科院分区：
文献类型：
--
作者：
Selvin, E;Marinopoulos, S;Golden, SH
背景：在糖尿病患者中，慢性高血糖（通过糖化血红蛋白水平评估）与微血管疾病的发展有关；然而，糖化血红蛋白与大血管疾病的关系尚不清楚。目的：对糖尿病患者糖化血红蛋白与心血管疾病之间关系的观察性研究进行荟萃分析。数据来源：通过使用医学主题标题搜索与糖化血红蛋白、糖尿病和心血管疾病相关的关键词和术语搜索MEDLINE数据库。研究选择：具有糖化血红蛋白水平和心血管疾病发生率数据的前瞻性队列研究。资料提取：从符合纳入标准的每个队列研究中推导或提取相对风险估计值。数据综合：通过使用随机效应模型，对糖化血红蛋白（总糖化血红蛋白、血红蛋白A或血红蛋白A、c水平）和心血管疾病事件（冠心病和中风）调整后的相对风险估计进行汇总。3项研究涉及1型糖尿病患者（n = 1688）， 10项研究涉及2型糖尿病患者（n = 7435）。心血管疾病的总相对危险度为1.18；这表明2型糖尿病患者的糖化血红蛋白水平增加了1个百分点（95% Cl， 1.10至1.26）。1型糖尿病患者的结果相似，但Cl值更大（合并相对危险度为1.15 [Cl， 0.92至1.43]）。局限性：本综述在很大程度上反映了文献的局限性。重要的问题是残留混淆、发表偏倚的可能性、研究数量少以及研究结果的异质性。结论：该分析表明，观察性研究与有限的临床试验数据一致，并提示慢性高血糖与糖尿病患者心血管疾病风险增加有关，尚待大型临床试验的证实。
Background: in persons with diabetes, chronic hyperglycemia (assessed by glycosylated hemoglobin level) is related to the development of microvascular disease; however, the relation of glycosylated hemoglobin to macrovascular disease is less clear.Purpose: To conduct a meta-analysis of observational studies of the association between glycosylated hemoglobin and cardiovascular disease in diabetic persons.Data Sources: search of the MEDLINE database by using Medical Subject Heading search terms and key words related to glycosylated hemoglobin, diabetes, and cardiovascular disease.Study Selection: Prospective cohort studies with data on glycosylated hemoglobin levels and incident cardiovascular disease.Data Extraction: Relative risk estimates were derived or abstracted from each cohort study that met the inclusion criteria.Data Synthesis: Adjusted relative risk estimates for glycosylated hemoglobin (total glycosylated hemoglobin, hemoglobin A, or hemoglobin A,c levels) and cardiovascular disease events (coronary heart disease and stroke) were pooled by using random-effects models. Three studies involved persons with type 1 diabetes (n = 1688), and 10 studies involved persons with type 2 diabetes (n = 7435). The pooled relative risk for cardiovascular disease was 1.18; this represented a 1-percentage point increase in glycosylated hemoglobin level (95% Cl, 1.10 to 1.26) in persons with type 2 diabetes. Results in persons with type I diabetes were similar but had a wider Cl (pooled relative risk, 1.15 [Cl, 0.92 to 1.43]).Limitations: This review largely reflects the limitations of the literature. Important concerns were residual confounding, the possibility of publication bias, the small number of studies, and the heterogeneity of study results.Conclusions: Pending confirmation from large, ongoing clinical trials, this analysis shows that observational studies are consistent with limited clinical trial data and suggests that chronic hyperglycemia is associated with an increased risk for cardiovascular disease in persons with diabetes.