Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies.
Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies.
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DOI：
10.1016/s0140-6736(10)60484-9
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发表时间：
2010-06-26
期刊：
影响因子：
168.9
通讯作者：
Danesh, J.
中科院分区：
文献类型：
--
作者：
Sarwar, N.;Gao, P.;Seshasai, S. R. Kondapally;Gobin, R.;Kaptoge, S.;Di Angelantonio, E.;Ingelsson, E.;Lawlor, D. A.;Selvin, E.;Stampfer, M.;Stehouwer, C. D. A.;Lewington, S.;Pennells, L.;Thompson, A.;Sattar, N.;White, I. R.;Ray, K. K.;Danesh, J.;Tipping, R. W.;Ford, C. E.;Pressel, S. L.;Folsom, A. R.;Chambless, L. E.;Wagenknecht, L. E.;Panagiotakos, D. B.;Pitsavos, C.;Chrysohoou, C.;Stefanadis, C.;Knuiman, M.;Whincup, P. H.;Wannamethee, S. G.;Morris, R. W.;Kiechl, S.;Willeit, J.;Oberhollenzer, F.;Mayr, A.;Wald, N.;Ebrahim, S.;Yarnell, J. W.;Gallacher, J.;Casiglia, E.;Tikhonoff, V.;Nietert, P. J.;Sutherland, S. E.;Bachman, D. L.;Keil, J. E.;de Boer, I. H.;Kizer, J. R.;Mukamal, K. J.;Tybjaerg-Hansen, A.;Nordestgaard, B. G.;Benn, M.;Frikke-Schmidt, R.;Giampaoli, S.;Palmieri, L.;Panico, S.;Vanuzzo, D.;Pilotto, L.;de la Camara, A. Gomez;Rubio, M. A.;Simons, L.;McCallum, J.;Friedlander, Y.;Fowkes, F. G. R.;Lee, A. J.;Taylor, J.;Guralnik, J. M.;Phillips, C. L.;Wallace, R.;Guralnik, J. M.;Phillips, C. L.;Blazer, D. G.;Guralnik, J. M.;Phillips, C. L.;Phillips, C. L.;Guralnik, J. M.;Khaw, K. T.;Brenner, H.;Raum, E.;Mueller, H.;Rothenbacher, D.;Jansson, J. H.;Wennberg, P.;Nissinen, A.;Donfrancesco, C.;Giampaoli, S.;Salomaa, V.;Harald, K.;Jousilahti, P.;Vartiainen, E.;Woodward, M.;D'Agostino, R. B.;Vasan, R. S.;Fox, C. S.;Pencina, M. J.;Bladbjerg, E.;Jorgensen, T.;Moller, L.;Jespersen, J.;Dankner, R.;Chetrit, A.;Lubin, F.;Wilhelmsen, L.;Eriksson, H.;Svardsudd, K.;Welin, L.;Rosengren, A.;Wilhelmsen, L.;Lappas, G.;Eriksson, H.;Bjorkelund, C.;Lissner, L.;Bengtsson, C.;Cremer, P.;Nagel, D.;Strandberg, T. E.;Salomaa, V.;Tilvis, R. S.;Miettinen, T. A.;Tilvis, R. S.;Strandberg, T. E.;Kiyohara, Y.;Arima, H.;Doi, Y.;Ninomiya, T.;Rodriguez, B.;Dekker, J. M.;Nijpels, G.;Stehouwer, C. D. A.;Rimm, E.;Pai, J. K.;Sato, S.;Iso, H.;Kitamura, A.;Noda, H.;Goldbourt, U.;Nyyssonen, K.;Tuomainen, T. P.;Salonen, J. T.;Deeg, D.;Poppelaars, J. L.;Meade, T. W.;Cooper, J. A.;Hedblad, B.;Berglund, G.;Engstrom, G.;Verschuren, W. M. M.;Blokstra, A.;Cushman, M.;Folsom, A. R.;Psaty, B. M.;Shea, S.;Doring, A.;Koenig, W.;Meisinger, C.;Mraz, W.;Verschuren, W. M. M.;Blokstra, A.;Bueno-de-Mesquita, H. Bas;Wilhelmsen, L.;Rosengren, A.;Lappas, G.;Fletcher, A.;Kuller, L. H.;Grandits, G.;Selmer, R.;Tverdal, A.;Nystad, W.;Gillum, R.;Mussolino, M.;Rimm, E.;Hankinson, S.;Manson, J. E.;Pai, J. K.;Salomaa, V.;Harald, K.;Jousilahti, P.;Vartiainen, E.;Cooper, J. A.;Bauer, K. A.;Davidson, K. W.;Kirkland, S.;Shaffer, J.;Korin, M. R.;Kitamura, A.;Sato, S.;Iso, H.;Holme, I.;Selmer, R.;Tverdal, A.;Nystad, W.;Ducimetiere, P.;Jouven, X.;Bakker, S. J. L.;Gansevoort, R. T.;Hillege, H. L.;Crespo, C. J.;Palmieri, M. R. Garcia;Amouyel, P.;Arveiler, D.;Evans, A.;Ferrieres, J.;Schulte, H.;Assmann, G.;Westendorp, R. G.;Buckley, B. M.;Packard, C. J.;Sattar, N.;Cantin, B.;Lamarche, B.;Despres, J. P.;Dagenais, G. R.;Barrett-Connor, E.;Wingard, D. L.;Bettencourt, R.;Gudnason, V.;Aspelund, T.;Sigurdsson, G.;Thorsson, B.;Trevisan, M.;Witteman, J.;Kardys, I.;Breteler, M.;Hofman, A.;Tunstall-Pedoe, H.;Tavendale, R.;Lowe, G. D. O.;Woodward, M.;Howard, B. V.;Zhang, Y.;Best, L.;Umans, J.;Ben-Shlomo, Y.;Davey-Smith, G.;Onat, A.;Hergenc, G.;Can, G.;Njolstad, I.;Mathiesen, E. B.;Lochen, M. L.;Wilsgaard, T.;Zethelius, B.;Riserus, U.;Berne, C.;Ingelsson, E.;Gaziano, J. M.;Stampfer, M.;Ridker, P.;Gaziano, J. M.;Ridker, P.;Ulmer, H.;Diem, G.;Concin, H.;Tosetto, A.;Rodeghiero, F.;Manson, J. E.;Tinker, L.;Liu, S.;Howard, B. V.;Marmot, I. M.;Clarke, R.;Collins, R.;Fletcher, A.;Brunner, E.;Shipley, M.;Ridker, P.;Buring, J.;Shepherd, J.;Cobbe, S. M.;Ford, I.;Robertson, M.;Ibanez, A. Marin;Feskens, E. J. M.;Kromhout, D.;Walker, M.;Watson, S.;Alexander, M.;Di Angelantonio, E.;Erqou, S.;Gao, P.;Gobin, R.;Haycock, P.;Kaptoge, S.;Seshasai, S. R. Kondapally;Lewington, S.;Pennells, L.;Perry, P. L.;Ray, K. K.;Sarwar, N.;Thompson, A.;Thompson, S. G.;Walker, M.;Watson, S.;White, I. R.;Wood, A. M.;Wormser, D.;Danesh, J.
糖尿病和空腹血糖浓度与冠心病和主要卒中亚型风险之间的相关性程度一直没有定论。我们的目标是在广泛的情况下量化这些关联。我们对来自新兴风险因素协作组研究的无初始血管疾病患者的糖尿病、空腹血糖浓度和其他风险因素的个体记录进行了荟萃分析。我们结合研究内回归，调整了年龄、性别、吸烟、收缩压和体重指数，以计算血管疾病的风险比（HR）。分析包括来自102项前瞻性研究的698782人的数据（52765例非致命性或致命性血管结局; 849万人-年的风险）。 糖尿病校正HR为：2.00（95% CI 1.83 - 2.19），缺血性卒中2.27（1.95 - 2.65），出血性卒中1.56（1.19 - 2.05），未分类卒中1.84（1.59 - 2.13），其他血管性死亡合计1.73（1.51 - 1.98）。在进一步调整脂质、炎症或肾脏标志物后，HR没有明显变化。女性冠心病的HR高于男性，40-59岁的患者高于70岁及以上的患者，致死性疾病的HR高于非致死性疾病的HR。在10%的成人人群中，糖尿病估计占血管性死亡的11%（10-12%）。空腹血糖浓度与血管风险呈非线性相关，在3.90 mmol/L和5.59 mmol/L之间无显著相关性。与空腹血糖浓度3.90 ~ 5.59 mmol/L相比，冠心病的HR为：低于3.90 mmol/L为1.07（0.97 ~ 1.18）; 5.60 ~ 6.09 mmol/L为1.11（1.04 ~ 1.18）; 6.10 ~ 6.99 mmol/L为1.17（1.08 ~ 1.26）。在没有糖尿病史的人群中，当将空腹血糖浓度或空腹血糖受损状态的信息添加到几个传统风险因素的信息中时，并没有显著改善血管疾病预测的指标。糖尿病使多种血管疾病的风险增加两倍，与其他常规风险因素无关。在非糖尿病人群中，空腹血糖浓度与血管疾病风险呈中度非线性相关。英国心脏基金会、英国医学研究理事会和辉瑞公司。
Uncertainties persist about the magnitude of associations of diabetes mellitus and fasting glucose concentration with risk of coronary heart disease and major stroke subtypes. We aimed to quantify these associations for a wide range of circumstances. We undertook a meta-analysis of individual records of diabetes, fasting blood glucose concentration, and other risk factors in people without initial vascular disease from studies in the Emerging Risk Factors Collaboration. We combined within-study regressions that were adjusted for age, sex, smoking, systolic blood pressure, and body-mass index to calculate hazard ratios (HRs) for vascular disease. Analyses included data for 698 782 people (52 765 non-fatal or fatal vascular outcomes; 8·49 million person-years at risk) from 102 prospective studies. Adjusted HRs with diabetes were: 2·00 (95% CI 1·83–2·19) for coronary heart disease; 2·27 (1·95–2·65) for ischaemic stroke; 1·56 (1·19–2·05) for haemorrhagic stroke; 1·84 (1·59–2·13) for unclassified stroke; and 1·73 (1·51–1·98) for the aggregate of other vascular deaths. HRs did not change appreciably after further adjustment for lipid, inflammatory, or renal markers. HRs for coronary heart disease were higher in women than in men, at 40–59 years than at 70 years and older, and with fatal than with non-fatal disease. At an adult population-wide prevalence of 10%, diabetes was estimated to account for 11% (10–12%) of vascular deaths. Fasting blood glucose concentration was non-linearly related to vascular risk, with no significant associations between 3·90 mmol/L and 5·59 mmol/L. Compared with fasting blood glucose concentrations of 3·90–5·59 mmol/L, HRs for coronary heart disease were: 1·07 (0·97–1·18) for lower than 3·90 mmol/L; 1·11 (1·04–1·18) for 5·60–6·09 mmol/L; and 1·17 (1·08–1·26) for 6·10–6·99 mmol/L. In people without a history of diabetes, information about fasting blood glucose concentration or impaired fasting glucose status did not significantly improve metrics of vascular disease prediction when added to information about several conventional risk factors. Diabetes confers about a two-fold excess risk for a wide range of vascular diseases, independently from other conventional risk factors. In people without diabetes, fasting blood glucose concentration is modestly and non-linearly associated with risk of vascular disease. British Heart Foundation, UK Medical Research Council, and Pfizer.