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前驱糖尿病与全因死亡和心血管疾病风险呈正相关
作者:小柯机器人 发布时间:2020/7/20 16:04:19

南方医科大学黄裕立课题组对前驱糖尿病与全因死亡和心血管疾病风险的相关性进行了最新的荟萃分析。2020年7月15日,该研究发表在《英国医学杂志》上。

为了评估在一般人群和有动脉粥样硬化性心血管疾病史的患者中,前驱糖尿病与全因死亡和心血管疾病发病风险之间的关联,研究组对PubMed、Embase和Google Scholar数据库中2020年4月25日之前的研究进行检索,筛选出关于前驱糖尿病与正常血糖者相比,全因死亡或心血管疾病校正后相对风险、优势比或风险比的研究,并进行荟萃分析。

研究组共纳入129项研究,涉及10069955参与者。在一般人群中,中位随访9.8年后,前驱糖尿病与全因死亡(相对风险为1.13)、复合心血管疾病(1.15)、冠心病(1.16)和中风(1.14)的风险增加有关。与正常血糖者相比,前驱糖尿病者中全因死亡、复合心血管疾病、冠心病和中风的绝对风险差异分别为每1万人年7.36、8.75、6.59和3.68例。

与空腹血糖受损相比,糖耐量异常者全因死亡、冠心病和中风的风险更高。在患有动脉粥样硬化性心血管疾病的患者中,中位随访3.2年后,前驱糖尿病与全因死亡(相对风险为1.36)、复合心血管疾病(1.37)和冠心病(1.15)的风险增加有关,但与卒中风险无关(1.05)。

在患有动脉粥样硬化性心血管疾病的患者中,与正常血糖相比,前驱糖尿病者中全因死亡、复合心血管疾病、冠心病和中风的绝对风险差异分别为每1万人年66.19、189.77、40.62和8.54例。对于患有动脉粥样硬化性心血管疾病的患者,不同定义的前驱糖尿病所有结局的风险均未发现显著的异质性。

研究结果表明,在普通人群和动脉粥样硬化性心血管疾病的患者中,前驱糖尿病与全因死亡和心血管疾病风险增加相关。糖尿病筛查和适当管理有助于心血管疾病的一级和二级预防。

附:英文原文

Title: Association between prediabetes and risk of all cause mortality and cardiovascular disease: updated meta-analysis

Author: Xiaoyan Cai, Yunlong Zhang, Meijun Li, Jason HY Wu, Linlin Mai, Jun Li, Yu Yang, Yunzhao Hu, Yuli Huang

Issue&Volume: 2020/07/15

Abstract: Objective To evaluate the associations between prediabetes and the risk of all cause mortality and incident cardiovascular disease in the general population and in patients with a history of atherosclerotic cardiovascular disease.

Design Updated meta-analysis.

Data sources Electronic databases (PubMed, Embase, and Google Scholar) up to 25 April 2020.

Review methods Prospective cohort studies or post hoc analysis of clinical trials were included for analysis if they reported adjusted relative risks, odds ratios, or hazard ratios of all cause mortality or cardiovascular disease for prediabetes compared with normoglycaemia. Data were extracted independently by two investigators. Random effects models were used to calculate the relative risks and 95% confidence intervals. The primary outcomes were all cause mortality and composite cardiovascular disease. The secondary outcomes were the risk of coronary heart disease and stroke.

Results A total of 129 studies were included, involving 10069955 individuals for analysis. In the general population, prediabetes was associated with an increased risk of all cause mortality (relative risk 1.13, 95% confidence interval 1.10 to 1.17), composite cardiovascular disease (1.15, 1.11 to 1.18), coronary heart disease (1.16, 1.11 to 1.21), and stroke (1.14, 1.08 to 1.20) in a median follow-up time of 9.8 years. Compared with normoglycaemia, the absolute risk difference in prediabetes for all cause mortality, composite cardiovascular disease, coronary heart disease, and stroke was 7.36 (95% confidence interval 9.59 to 12.51), 8.75 (6.41 to 10.49), 6.59 (4.53 to 8.65), and 3.68 (2.10 to 5.26) per 10000 person years, respectively. Impaired glucose tolerance carried a higher risk of all cause mortality, coronary heart disease, and stroke than impaired fasting glucose. In patients with atherosclerotic cardiovascular disease, prediabetes was associated with an increased risk of all cause mortality (relative risk 1.36, 95% confidence interval 1.21 to 1.54), composite cardiovascular disease (1.37, 1.23 to 1.53), and coronary heart disease (1.15, 1.02 to 1.29) in a median follow-up time of 3.2 years, but no difference was seen for the risk of stroke (1.05, 0.81 to 1.36). Compared with normoglycaemia, in patients with atherosclerotic cardiovascular disease, the absolute risk difference in prediabetes for all cause mortality, composite cardiovascular disease, coronary heart disease, and stroke was 66.19 (95% confidence interval 38.60 to 99.25), 189.77 (117.97 to 271.84), 40.62 (5.42 to 78.53), and 8.54 (32.43 to 61.45) per 10 000 person years, respectively. No significant heterogeneity was found for the risk of all outcomes seen for the different definitions of prediabetes in patients with atherosclerotic cardiovascular disease (all P>0.10).

Conclusions Results indicated that prediabetes was associated with an increased risk of all cause mortality and cardiovascular disease in the general population and in patients with atherosclerotic cardiovascular disease. Screening and appropriate management of prediabetes might contribute to primary and secondary prevention of cardiovascular disease.

DOI: 10.1136/bmj.m2297

Source: https://www.bmj.com/content/370/bmj.m2297

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj