Effect of pre-diabetes on future risk of stroke: meta-analysis.
Effect of pre-diabetes on future risk of stroke: meta-analysis.
复制标题
DOI：
10.1136/bmj.e3564
复制
发表时间：
2012-06-07
期刊：
影响因子：
--
通讯作者：
Ovbiagele B
中科院分区：
文献类型：
--
作者：
Lee M;Saver JL;Hong KS;Song S;Chang KH;Ovbiagele B
目的评估糖尿病前期与卒中风险之间的关系，并评估这种关系是否因糖尿病前期的诊断标准而异。设计前瞻性研究的系统回顾和荟萃分析。数据来源检索Medline、Embase和科克伦图书馆（1947年至2011年7月16日），并对关键检索文章的参考书目和相关综述进行手动检索。入选标准：前瞻性队列研究，报告了与基线糖尿病前期相比卒中的多变量校正相对风险和相应的95%置信区间。数据提取两名独立的评审员提取了基线时糖尿病前期状态、卒中风险估计、研究质量以及用于评估糖尿病前期和卒中的方法的数据。适当时，使用随机效应模型合并相对风险。在代表不同参与者和研究特征的亚组中测试了相关性。用漏斗图评价发表偏倚。结果共检索到15个前瞻性队列研究，纳入760925例受试者。在8项分析糖尿病前期（定义为空腹血糖100-125 mg/dL（5.6-6.9 mmol/L））的研究中，随机效应汇总估计值未显示在调整既定心血管风险因素后卒中风险增加（1.08，95%置信区间0.94 - 1.23; P=0.26）。在5项分析糖尿病前期（定义为空腹血糖110-125 mg/dL（6.1-6.9 mmol/L））的研究中，随机效应汇总估计值显示，在调整了既定的心血管风险因素后，卒中风险增加（1.21，1.02 - 1.44; P=0.03）。在8项包含糖耐量减低或糖耐量减低合并空腹血糖受损信息的研究中，随机效应汇总估计值显示，在校正了已确定的心血管危险因素后，卒中风险增加（1.26，1.10 - 1.43; P<0.001）。当排除可能招募未确诊糖尿病患者的研究时，只有糖耐量受损或空腹血糖受损和糖耐量受损的组合独立地增加了未来卒中的风险（1.20，1.07至1.35; P=0.002）。结论糖尿病前期（定义为糖耐量受损或空腹血糖受损和糖耐量受损的组合）可能与未来卒中的较高风险相关，但相对风险适中，可能反映了潜在的混杂因素。
Objectives To assess the association between pre-diabetes and risk of stroke, and to evaluate whether this relation varies by diagnostic criteria for pre-diabetes. Design Systematic review and meta-analysis of prospective studies. Data sources A search of Medline, Embase, and the Cochrane Library (1947 to 16 July 2011) was supplemented by manual searches of bibliographies of key retrieved articles and relevant reviews. Selection criteria Prospective cohort studies that reported multivariate adjusted relative risks and corresponding 95% confidence intervals for stroke with respect to baseline pre-diabetes were included. Data extraction Two independent reviewers extracted data on pre-diabetes status at baseline, risk estimates of stroke, study quality, and methods used to assess pre-diabetes and stroke. Relative risks were pooled using random effects models when appropriate. Associations were tested in subgroups representing different characteristics of participants and studies. Publication bias was evaluated with funnel plots. Results The search yielded 15 prospective cohort studies including 760 925 participants. In 8 studies analysing pre-diabetes defined as fasting glucose 100-125 mg/dL (5.6-6.9 mmol/L), the random effects summary estimate did not show an increased risk of stroke after adjustment for established cardiovascular risk factors (1.08, 95% confidence interval 0.94 to 1.23; P=0.26). In 5 studies analysing pre-diabetes defined as fasting glucose 110-125 mg/dL (6.1-6.9 mmol/L), the random effects summary estimate showed an increased risk of stroke after adjustment for established cardiovascular risk factors (1.21, 1.02 to 1.44; P=0.03). In 8 studies with information about impaired glucose tolerance or combined impaired glucose tolerance and impaired fasting glucose, the random effects summary estimate showed an increased risk of stroke after adjustment for established cardiovascular risk factors (1.26, 1.10 to 1.43; P<0.001). When studies that might have enrolled patients with undiagnosed diabetes were excluded, only impaired glucose tolerance or a combination of impaired fasting glucose and impaired glucose tolerance independently raised the future risk of stroke (1.20, 1.07 to 1.35; P=0.002). Conclusion Pre-diabetes, defined as impaired glucose tolerance or a combination of impaired fasting glucose and impaired glucose tolerance, may be associated with a higher future risk of stroke, but the relative risks are modest and may reflect underlying confounding.