Association of Random Plasma Glucose Levels With the Risk for Cardiovascular Disease Among Chinese Adults Without Known Diabetes
Association of Random Plasma Glucose Levels With the Risk for Cardiovascular Disease Among Chinese Adults Without Known Diabetes
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DOI：
10.1001/jamacardio.2016.1702
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发表时间：
2016-10-01
期刊：
影响因子：
24
通讯作者：
Chen, Zhengming
中科院分区：
文献类型：
--
作者：
Bragg, Fiona;Li, Liming;Chen, Zhengming
糖尿病是心血管疾病（CVD）的一个已知危险因素。然而，关于血糖水平低于糖尿病阈值与心血管疾病风险的相关性，仍存在大量的不确定性。目的：研究随机血糖（RPG）水平与中国成年人主要心血管疾病风险之间的关系，这些成年人没有已知的糖尿病。设计、设置和参与者这项前瞻性队列研究包括467508名年龄在30至79岁之间的男性和女性，没有糖尿病史，缺血性心脏病（IHD）、中风或短暂性脑缺血发作。参与者于2004年6月25日至2008年7月15日从中国5个城市和5个农村不同地点招募，并随访至2014年1月1日。主要结局和指标心血管死亡、主要冠状动脉事件（MCE）（包括致死性I HD和非致死性心肌梗死）、缺血性卒中（IS）、严重闭塞性血管疾病（MOVD）（包括MCE或IS）和脑出血。对卒中和IHD事件的初步验证显示阳性预测值分别约为90%和85%。考克斯回归得出了与RPG水平相关的CVD校正风险比（aHR）。结果在467508名参与者中（41.0%男性; 59.0%女性;平均[SD]年龄，51 [11]岁），基线RPG水平与CVD风险的显著正相关持续至4.0 mmol/L（72 mg/dL）。校正回归稀释偏倚后，常规RPG水平每高于5.9 mmol/L（106 mg/dL）1 mmol/L（18 mg/dL），心血管死亡风险就增加11%（6645例死亡; aHR，1.11; 95% CI，1.10-1.13）。在MCE（3270起事件; aHR，1.10; 95% CI，1.08-1.13）、IS（19153起事件; aHR，1.08; 95% CI，1.07-1.09）和MOVD（22023起事件; aHR，1.08; 95% CI，1.07-1.09）中观察到类似的强阳性相关性。对于脑出血，相关性较弱，但也具有显著性（4326起事件; aHR，1.05; 95% CI，1.02-1.07）。这些协会持续排除参与者谁发展糖尿病在follow-up.CONCLUSIONS和RELEVANCE在中国成年人无糖尿病，较低的RPG水平与较低的风险，主要心血管疾病，即使在正常范围内的血糖水平。
IMPORTANCE Diabetes is a known risk factor for cardiovascular disease (CVD). Substantial uncertainty remains, however, about the relevance to CVD risk for blood glucose levels below the diabetes threshold.OBJECTIVE To examine the association of random plasma glucose (RPG) levels with the risk for major CVD in Chinese adults without known diabetes.DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included 467 508 men and women aged 30 to 79 years with no history of diabetes, ischemic heart disease (IHD), stroke, or transient ischemic attack. Participants were recruited from 5 urban and 5 rural diverse locations across China from June 25, 2004, to July 15, 2008, and followed up to January 1, 2014.EXPOSURES Baseline and usual (longer-term average) RPG level.MAIN OUTCOMES AND MEASURES Cardiovascular deaths, major coronary events (MCE) (including fatal I HD and nonfatal myocardial infarction), ischemic stroke (IS), major occlusive vascular disease (MOVD) (including MCE or IS), and intracerebral hemorrhage. Preliminary validation of stroke and IHD events demonstrated positive predictive values of approximately 90% and 85%, respectively. Cox regression yielded adjusted hazard ratios (aHRs) for CVD associated with RPG levels.RESULTS Among the 467 508 participants (41.0% men; 59.0% women; mean [SD] age, 51 [11] years), a significant positive association of baseline RPG levels with CVD risks continued to 4.0 mmol/L (72 mg/dL). After adjusting for regression dilution bias, each 1-mmol/L (18-mg/dL) higher usual RPG level above 5.9 mmol/L (106 mg/dL) was associated with an 11% higher risk for cardiovascular death (6645 deaths; aHR, 1.11; 95% Cl, 1.10-1.13). Similarly strong positive associations were seen for MCE (3270 events; aHR, 1.10; 95% Cl, 1.08-1.13), IS (19153 events; aHR, 1.08; 95% Cl, 1.07-1.09), and MOVD (22 023 events; aHR, 1.08; 95% Cl, 1.07-1.09). For intracerebral hemorrhage, the association was weaker, but also significant (4326 events; aHR, 1.05; 95% Cl, 1.02-1.07). These associations persisted after excluding participants who developed diabetes during follow-up.CONCLUSIONS AND RELEVANCE Among adult Chinese without diabetes, lower RPG levels are associated with lower risks for major CVDs, even within a normal range of blood glucose levels.