Glycated haemoglobin, diabetes, and mortality in men in Norfolk cohort of European Prospective Investigation of Cancer and Nutrition (EPIC-Norfolk)
Glycated haemoglobin, diabetes, and mortality in men in Norfolk cohort of European Prospective Investigation of Cancer and Nutrition (EPIC-Norfolk)
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DOI：
10.1136/bmj.322.7277.15
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发表时间：
2001-01-06
影响因子：
105.7
通讯作者：
Day, N
中科院分区：
文献类型：
--
作者：
Khaw, KT;Wareham, N;Day, N
目的探讨糖化血红蛋白（HbA（1c））浓度作为血糖浓度的标志物，作为男性心血管和所有原因死亡的预测因子。设计前瞻性人群研究。设置欧洲癌症和营养前瞻性研究的诺福克队列受试者4662名年龄在45-79岁之间的男性，他们在1995年的基线调查中测量了糖化血红蛋白，随访至1999年12月。主要结果测量所有原因、心血管疾病、缺血性心脏病和其他原因的死亡率。与无已知糖尿病的男性相比，所有原因，心血管疾病和缺血性疾病（相对风险分别为2.2，3.3和4.2，P < 0.001，独立于年龄和其他风险因素）。男性糖尿病患者死亡风险的增加在很大程度上是由HbA（1c）浓度解释的。在整个人群分布中，HbA（1c）与随后的全因、心血管和缺血性心脏病死亡率持续相关，HbA（1c）浓度低于5%的人群的死亡率最低。HbA（1c）增加1%与28%的（P < 0.002）死亡风险增加与年龄、血压、血清胆固醇、体重指数和吸烟习惯无关;这种影响仍然存在（相对危险度1.46，经年龄和危险因素调整后P = 0.05），在已知糖尿病的男性中，HbA（1c）浓度大于或等于7%，或有心肌梗死或脑卒中病史者除外。18%与HbA（1c）浓度大于或等于5%相关的人群超额死亡风险发生在糖尿病男性中，但82%发生在男性，浓度为5%-6.9%（大多数人口）结论：糖化血红蛋白浓度似乎可以解释男性糖尿病死亡率过高的大部分原因，并且在整个人群中是一个持续的危险因素。分布预防工作不仅需要考虑已确诊的糖尿病患者，还需要考虑是否有可能通过行为手段减少HbA（1c）的人群分布。
Objective To examine the value of glycated haemoglobin (HbA(1c)) concentration, a marker of blood glucose concentration, as a predictor of death from cardiovascular and all causes in men.Design Prospective population study.Setting Norfolk cohort of European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk).Subjects 4662 men aged 45-79 years who had had glycated haemoglobin measured at the baseline survey in-1995-7 who were followed up to December 1999.Main outcome measures Mortality from all causes, cardiovascular disease, ischaemic heart disease, and other causes.Results Men with known diabetes had increased mortality: from all causes, cardiovascular disease, and ischaemic disease (relative risks 2.2, 3.3, and 4.2, respectively, P < 0.001 independent of age and other risk factors) compared with men without known diabetes. The increased risk of death among men with diabetes was largely explained by HbA(1c) concentration. HbA(1c) was continuously related to subsequent all cause, cardiovascular, and ischaemic heart disease mortality through the whole population distribution, with lowest rates in those with HbA(1c) concentrations below 5%. An increase of 1% in HbA(1c) was associated with a 28% (P < 0.002) increase in risk of death independent of age, blood pressure, serum cholesterol, body mass index, and cigarette smoking habit; this effect remained (relative risk 1.46, P = 0.05 adjusted for age and risk factors) after men with known diabetes, a HbA(1c) concentration greater than or equal to 7%, or history of myocardial infarction or stroke were excluded. 18% of the population excess mortality risk associated with a HbA(1c) concentration greater than or equal to5% occurred in men with diabetes, but 82% occurred in men with concentrations of 5%-6.9% (the majority of the population).Conclusions Glycated haemoglobin concentration seems to explain most of the excess mortality risk of diabetes in men and to be a continuous risk factor through the whole population distribution. Preventive efforts need to consider not just chose with established diabetes but whether it is possible to reduce the population distribution of HbA(1c) through behavioural means.