The association between different A1C-based measures of glycemia and risk of cardiovascular disease hospitalization.
The association between different A1C-based measures of glycemia and risk of cardiovascular disease hospitalization.
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DOI：
10.2337/dc13-1300
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发表时间：
2014
期刊：
影响因子：
16.2
通讯作者：
Fortmann SP
中科院分区：
文献类型：
--
作者：
Nichols GA;Rosales AG;Perrin NA;Fortmann SP
我们测试了平均每月血糖负荷 (AMGB)（一种高血糖标志物，与 A1C 超过 7% 的程度和持续时间有关）是否表明比传统 A1C 测量方法有更高的心血管疾病 (CVD) 风险。我们采用病例对照设计，研究了 Kaiser Permanente Northwest 的 2,456 名患有 2 型糖尿病的成员：其中 1,228 名经历过 CVD 住院治疗的患者，将年龄、性别和糖尿病病程与 1,228 名未因 CVD 住院的患者进行了匹配。我们计算了从糖尿病诊断到 CVD 住院期间的 AMGB，作为每次实际或插值 A1C 测量值与 7% 之间差异的函数，从而得出高血糖暴露曲线下面积估计值，并根据观察月数进行调整。我们使用条件逻辑回归来比较几种基于 A1C 的血糖测量值和 CVD 之间的关联，并控制临床特征和合并症。 AMGB 与 29% 的 CVD 风险增加相关（比值比 1.29 [95% CI 1.16–1.44]；P < 0.001），而平均 A1C 与 22% 的风险增加相关（1.22 [1.09–1.37]；P < 0.001）。 A1C 超过 7% 与 CVD 风险增加 39% 相关 (1.39 [1.08–1.79]; P = 0.010)。没有一个具有血糖测量的模型比没有血糖测量的相同模型提供更多的信息。 AMGB 表现出比平均 A1C 更高的 CVD 风险，但其临床用途可能有限。 A1C 升至 7% (53 mmol/mol) 以上是 CVD 风险的简单预测指标，可能对新诊断的患者产生重要的临床影响。
We tested whether average monthly glycemic burden (AMGB), a marker of hyperglycemia that is a function of the extent and duration that A1C exceeded 7%, indicated greater risk of cardiovascular disease (CVD) than traditional A1C measures. Using a case-control design, we studied 2,456 members of Kaiser Permanente Northwest with type 2 diabetes: 1,228 who experienced a CVD hospitalization, matched on age, sex, and duration of diabetes to 1,228 patients who were not hospitalized for CVD. We calculated AMGB from diabetes diagnosis until CVD hospitalization as a function of the difference between each actual or interpolated A1C measurement and 7%, resulting in an area under the curve estimate of hyperglycemic exposure, adjusted for number of months of observation. We used conditional logistic regression to compare the association between several A1C-based measures of glycemia and CVD, controlling for clinical characteristics and comorbidities. AMGB was associated with increased CVD risk of 29% (odds ratio 1.29 [95% CI 1.16–1.44]; P < 0.001), while mean A1C was associated with a 22% risk increase (1.22 [1.09–1.37]; P < 0.001). A1C ever exceeding 7% was associated with increased CVD risk of 39% (1.39 [1.08–1.79]; P = 0.010). No model with a glycemia measure provided substantially more information than an identical model without a glycemia measure. AMGB demonstrated somewhat greater CVD risk than mean A1C, but its clinical usefulness may be limited. A1C ever rising above 7% (53 mmol/mol) was a simple predictor of CVD risk that may have important clinical ramifications for newly diagnosed patients.
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影响因子：
168.9
作者：
Turner, RC;Holman, RR;Ward, JD
通讯作者：
Ward, JD
影响因子：
158.5
作者：
Duckworth, William;Abraira, Carlos;Huang, Grant D.
通讯作者：
Huang, Grant D.
影响因子：
158.5
作者：
Holman, Rury R.;Paul, Sanjoy K.;Neil, H. Andrew W.
通讯作者：
Neil, H. Andrew W.
影响因子：
105.7
作者：
Stratton, IM;Adler, AI;Holman, RR
通讯作者：
Holman, RR
影响因子：
24
作者：
Aguilar, David;Bozkurt, Biykem;Ramasubbu, Kumudha;Deswal, Anita
通讯作者：
Deswal, Anita