Increased risk of ischemic heart disease, hypertension, and type 2 diabetes in women with previous gestational diabetes mellitus, a target group in general practice for preventive interventions: A population-based cohort study.
Increased risk of ischemic heart disease, hypertension, and type 2 diabetes in women with previous gestational diabetes mellitus, a target group in general practice for preventive interventions: A population-based cohort study.
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既往妊娠期糖尿病妇女缺血性心脏病、高血压和2型糖尿病的风险增加，预防干预的一般实践目标群体：一项基于人群的队列研究
DOI：
10.1371/journal.pmed.1002488
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发表时间：
2018-01
期刊：
影响因子：
15.8
通讯作者：
Nirantharakumar K
中科院分区：
文献类型：
--
作者：
Daly B;Toulis KA;Thomas N;Gokhale K;Martin J;Webber J;Keerthy D;Jolly K;Saravanan P;Nirantharakumar K
妊娠糖尿病（GDM）与2型糖尿病的发生有关，但很少有研究探讨其对心血管疾病的影响。我们利用英国大型初级保健数据库进行了一项回顾性队列研究。从1990年2月1日至2016年5月15日，确定了9，118名诊断为GDM的女性，并根据年龄和妊娠时间（最长3个月）与37，281名对照女性随机匹配。计算心血管危险因素和心血管疾病的校正发生率比（IRR）及其95%置信区间（CI）。在调整年龄、汤森（剥夺）五分位数、体重指数和吸烟后，GDM女性更容易患2型糖尿病（IRR = 21.96; 95% CI 18.31-26.34）和高血压（IRR = 1.85; 95% CI 1.59-2.16）。校正上述协变量和基线时的降脂药物和高血压后，缺血性心脏病（IHD）的IRR为2.78（95% CI 1.37-5.66），脑血管疾病的IRR为0.95（95% CI 0.51-1.77; p值= 0.87）。2型糖尿病和心血管危险因素的随访筛查较差。局限性包括：在初级保健中对女性重度GDM的潜在选择性记录，对诊断为GDM的女性结局的监测高于对照组女性，以及中位产后随访期短，IHD和脑血管疾病的结局数量较少。被诊断为GDM的女性患2型糖尿病的风险非常高，并且高血压和IHD的发病率显著增加。在全科实践中识别这组妇女并针对心血管风险因素可以改善长期结果。Krishnarajah Nirantharakumar及其同事展示了一组患有妊娠糖尿病的女性的结果，并将这些女性确定为心血管疾病和2型糖尿病预防干预的目标群体。妊娠期糖尿病（GDM）的患病率在大多数发达国家迅速增加。虽然有充分的证据表明，被诊断患有GDM的妇女患2型糖尿病的终生风险大大增加，但关于其与心血管疾病的相关性的报道很少。仅3项既往基于人群的队列研究报告了GDM和心血管事件的长期风险（包括1项使用初级保健数据库的研究），英国（UK）尚未报告研究。这项基于人群的回顾性队列研究利用了一个大型英国初级保健数据库，其中包括1990年2月1日至2016年5月15日期间诊断为GDM的9，000多名女性。研究了妊娠期糖尿病与产后2型糖尿病、高血压和心血管疾病的关系。被诊断患有GDM的女性患2型糖尿病的可能性是其他女性的20倍以上，患缺血性心脏病的可能性是其他女性的2.8倍，患高血压的可能性是其他女性的两倍，尽管没有发现与脑血管疾病的相关性。不到60%的被诊断患有GDM的妇女在产后第一年接受了2型糖尿病的初级保健筛查，并且在此期间之后筛查的比例迅速下降。心血管危险因素如吸烟、高体重指数、高血压和血脂异常的筛查率也较低，与对照组妇女的筛查率相似。女性GDM除了增加2型糖尿病之外，还增加了高血压和缺血性心脏病的风险。尽管国家健康与护理卓越研究所的指南建议每年对诊断为GDM的女性进行2型糖尿病筛查，但这项研究发现，2型糖尿病和其他心血管危险因素（如高血压）的随访筛查效果不佳。被诊断患有GDM的妇女是一组可识别的高危妇女，是针对预防性代谢和心血管干预的理想选择。临床指南应包括产后筛查和管理所有心血管危险因素的妇女诊断为GDM，而不限于糖尿病。
Gestational diabetes mellitus (GDM) is associated with developing type 2 diabetes, but very few studies have examined its effect on developing cardiovascular disease. We conducted a retrospective cohort study utilizing a large primary care database in the United Kingdom. From 1 February 1990 to 15 May 2016, 9,118 women diagnosed with GDM were identified and randomly matched with 37,281 control women by age and timing of pregnancy (up to 3 months). Adjusted incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated for cardiovascular risk factors and cardiovascular disease. Women with GDM were more likely to develop type 2 diabetes (IRR = 21.96; 95% CI 18.31–26.34) and hypertension (IRR = 1.85; 95% CI 1.59–2.16) after adjusting for age, Townsend (deprivation) quintile, body mass index, and smoking. For ischemic heart disease (IHD), the IRR was 2.78 (95% CI 1.37–5.66), and for cerebrovascular disease 0.95 (95% CI 0.51–1.77; p-value = 0.87), after adjusting for the above covariates and lipid-lowering medication and hypertension at baseline. Follow-up screening for type 2 diabetes and cardiovascular risk factors was poor. Limitations include potential selective documentation of severe GDM for women in primary care, higher surveillance for outcomes in women diagnosed with GDM than control women, and a short median follow-up postpartum period, with a small number of outcomes for IHD and cerebrovascular disease. Women diagnosed with GDM were at very high risk of developing type 2 diabetes and had a significantly increased incidence of hypertension and IHD. Identifying this group of women in general practice and targeting cardiovascular risk factors could improve long-term outcomes. Krishnarajah Nirantharakumar and colleagues present results from a cohort of women with gestational diabetes and identify these as a target group for preventative interventions for cardiovascular disease and type 2 diabetes. The prevalence of gestational diabetes mellitus (GDM) is increasing rapidly in most developed countries. Although it is well documented that women diagnosed with GDM have a greatly increased lifetime risk of developing type 2 diabetes, there is a paucity of reports on its association with cardiovascular disease. Only 3 previous population-based cohort studies have reported on GDM and the long-term risk of cardiovascular events (including 1 utilizing a primary care database), and no studies have been reported from the United Kingdom (UK). This population-based retrospective cohort study utilized a large UK primary care database that included more than 9,000 women diagnosed with GDM between 1 February 1990 and 15 May 2016. The association between GDM and the development of type 2 diabetes, hypertension, and cardiovascular disease postpartum was examined. Women diagnosed with GDM were over 20 times more likely to develop type 2 diabetes, 2.8 times more likely to develop ischemic heart disease, and twice as likely to develop hypertension, although no association was found for cerebrovascular disease. Less than 60% of women diagnosed with GDM were screened in primary care for type 2 diabetes in the first year postpartum, and the proportion screened rapidly declined after this period. Screening rates were also low for cardiovascular risk factors such as smoking, high body mass index, hypertension, and dyslipidemia, and were similar to the screening rates in control women. GDM in women increases the risk for hypertension and ischemic heart disease in addition to type 2 diabetes. Although the National Institute for Health and Care Excellence guidelines recommend annual screening for type 2 diabetes in women diagnosed with GDM, this study found that follow-up screening was poor for type 2 diabetes and other cardiovascular risk factors such as hypertension. Women diagnosed with GDM are an identifiable group of at-risk women and ideal for targeting preventative metabolic and cardiovascular interventions. Clinical guidelines should include postpartum screening and management for all cardiovascular risk factors in women diagnosed with GDM and not restrict it to diabetes.
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影响因子：
2
作者：
Kusunoki, Yoshiki;Katsuno, Tomoyuki;Namba, Mitsuyoshi
通讯作者：
Namba, Mitsuyoshi
影响因子：
5.8
作者：
Ratner, Robert E.;Christophi, Costas A.;Kahn, Steven E.
通讯作者：
Kahn, Steven E.
DOI：
10.1111/dme.12382
发表时间：
2014-03
期刊：
Diabetic medicine : a journal of the British Diabetic Association
影响因子：
--
作者：
Kim C
通讯作者：
Kim C
影响因子：
12.7
作者：
Kim, Catherine;Tabaei, Bahman P.;Herman, William H.
通讯作者：
Herman, William H.
影响因子：
16.2
作者：
Carr, Darcy B.;Heckbert, Susan R.;Shofer, Jane B.
通讯作者：
Shofer, Jane B.