Diabetes, Glycated Hemoglobin, and the Risk of Myocardial Infarction in Women and Men: A Prospective Cohort Study of the UK Biobank
Diabetes, Glycated Hemoglobin, and the Risk of Myocardial Infarction in Women and Men: A Prospective Cohort Study of the UK Biobank
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DOI：
10.2337/dc19-2363
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发表时间：
2020-09-01
期刊：
影响因子：
16.2
通讯作者：
Peters, Sanne A. E.
中科院分区：
文献类型：
--
作者：
de Jong, Marit;Woodward, Mark;Peters, Sanne A. E.
目的糖尿病已被证明是女性心肌梗死（MI）的一个更强的危险因素。血糖谱中是否存在性别差异尚不清楚。我们调查了糖尿病状态和糖化血红蛋白（HbA（1c））与MI风险之间的性别差异。研究设计和方法数据来自英国生物库中471，399名（56%女性）无心血管疾病（CVD）的个体。根据糖尿病状态和HbA（1c）水平，使用Poisson回归计算性别特异性发病率。考克斯比例风险分析在平均9年的随访期间，根据糖尿病状态和HbA（1c）对MI进行估计的性别特异性风险比（HR）和女性与男性的比值。结果无论是否患有糖尿病或HbA（1c）水平如何，女性MI的发生率均低于男性。与无糖尿病的个体相比，糖尿病前期、未诊断的糖尿病和既往诊断的糖尿病与男性和女性MI风险增加相关。既往诊断的糖尿病与女性MI的相关性（HR 2.33 [95% CI 1.96; 2.78]）高于男性（1.81 [1.63; 2.02]），女性与男性的HR比为1.29（1.05; 1.58）。HbA（1c）每高1%，与糖尿病状态无关，与女性和男性MI风险增加18%相关。结论：虽然男性MI的发病率高于女性，但女性中糖尿病的存在与MI的相对风险更高相关。然而，HbA（1c）每增加1%，女性和男性的MI风险都增加18%。
OBJECTIVE Diabetes has shown to be a stronger risk factor for myocardial infarction (MI) in women than men. Whether sex differences exist across the glycemic spectrum is unknown. We investigated sex differences in the associations of diabetes status and glycated hemoglobin (HbA(1c)) with the risk of MI. RESEARCH DESIGN AND METHODS Data were used from 471,399 (56% women) individuals without cardiovascular disease (CVD) included in the UK Biobank. Sex-specific incidence rates were calculated by diabetes status and across levels of HbA(1c)using Poisson regression. Cox proportional hazards analyses estimated sex-specific hazard ratios (HRs) and women-to-men ratios by diabetes status and HbA(1c)for MI during a mean follow-up of 9 years. RESULTS Women had lower incidence rates of MI than men, regardless of diabetes status or HbA(1c)level. Compared with individuals without diabetes, prediabetes, undiagnosed diabetes, and previously diagnosed diabetes were associated with an increased risk of MI in both sexes. Previously diagnosed diabetes was more strongly associated with MI in women (HR 2.33 [95% CI 1.96; 2.78]) than men (1.81 [1.63; 2.02]), with a women-to-men ratio of HRs of 1.29 (1.05; 1.58). Each 1% higher HbA(1c), independent of diabetes status, was associated with an 18% greater risk of MI in both women and men. CONCLUSIONS Although the incidence of MI was higher in men than women, the presence of diabetes is associated with a greater excess relative risk of MI in women. However, each 1% higher HbA(1c)was associated with an 18% greater risk of MI in both women and men.