Association of two-hour post-load and fasting plasma glucose with cardiovascular diseases among people with normal glucose tolerance
-
摘要:
目的 探讨正常糖耐量范围内,空腹和2 h血糖与中国成人心脑血管疾病关联性,为心脑血管疾病危险因素的早期防控提供依据。 方法 以4 307名35~74岁成年人中空腹血糖(FPG)< 6.1 mmol/L且2 h血糖(2hPG) < 7.8 mmol/L糖耐量正常者为对象,采用多因素logistic回归分析评估2hPG > FPG组与2hPG≤FPG组人群心脑血管疾病患病率的风险比。 结果 4 307名成年人中确诊心脑血管疾病患者1 815例,2hPG > FPG组人群心脑血管病患病率(42.4 %)高于2hPG≤FPG组(36.2 %)(P < 0.01);与2hPG≤FPG组比较,2hPG > FPG组人群年龄偏大、体质指数、舒张压、总胆固醇、甘油三酯和胰岛素水平较高(P < 0.01)。多因素logistic回归分析显示,2hPG > FPG、年龄、体质指数、甘油三酯和饮酒状况可增加心脑血管病风险,OR值及其95 % CI分别为1.210(1.042~1.405)、1.073(1.064~1.082)、1.170(1.144~1.196)、1.396(1.127~1.729)和1.269(1.154~1.396)。分层分析结果显示,在女性、年龄 < 60岁及FPG < 5.6 mmol/L亚组中,2hPG > FPG组人群心脑血管疾病患病风险较高;调整蔬菜、水果摄入、胰岛素抵抗和胰岛分泌水平后,2hPG > FPG组人群心脑血管病患病风险降低。 结论 正常血糖下,较高的2 h血糖可能增加心脑血管疾病患病风险。 Abstract:Objective To explore the association of fasting plasma glucose (FPG) and two hour post-load plasma glucose (2hPG) with cardiovascular diseases (CVD) among adults with normal glucose tolerance (NGT) and to provide evidences for prevention and control of risk factors of CVD in China. Methods We randomly selected 4 307 permanent residents aged 35 – 74 years and with normal FPG (< 6.1 mmol/L) and 2hPG (<7.8 mmol/L) in 3 urban districts and 3 villages in Qingdao municipality. Multivariate adjusted odds ratio (ORs) and its 95% confidence interval (95% CI) for incidence of CVD were estimated for individuals with 2hPG > FPG as compared with those with 2hPG≤FPG, controlling for underlying confounders. Results Of all the participants, 1 815 were identified with CVD. The prevalence of CVD was significantly higher in the participants with 2hPG > FPG than in those with 2hPG≤FPG (42.4% vs. 36.2%)(P < 0.01). Compared with those with 2hPG≤FPG, the participants with 2hPG > FPG were at older age and had higher body mass index, diastolic blood pressure, total cholesterol, triglycerides, and insulin secretion (P < 0.01 for all). Multivariate logistic regression analysis demonstrated that the participants with following characteristics were at a higher risk of CVD: 2hPG > FPG (OR = 1.210, 95% CI: 1.042 – 1.405), elder age (OR = 1.073, 95% CI: 1.064 – 1.082), high body mass index (OR = 1.170, 95% CI: 1.144 – 1.196), high triglyceride (OR = 1.396, 95% CI: 1.127 – 1.729), and alcohol drinking (1.269, 95% CI: 1.154 – 1.396). Stratified analysis revealed that for the female participants aged < 60 years and FPG < 5.6 mmol/L, those with 2hPG > FPG were at a higher risk of CVD compared to those with 2hPG≤FPG. The risk of CVD was attenuated among the participants with 2hPG > FPG after adjusting for vegetable and fruit consumption, insulin resistance, and insulin secretion. Conclusion The elevated 2hPG is associated significantly with increased risk of CVD among community adults with normal glucose tolerance. -
Key words:
- normal glucose tolerance /
- insulin resistance /
- cardiovascular disease /
- risk factor
-
表 1 2hPG≤FPG与2hPG > FPG组人群不同人口学特征比较(%)
人口学特征 2hPG ≤ FPG
(n = 1 383)2hPG > FPG
(n = 2 924)χ2值 P值 性别 男性 41.0 59.0 100.479 0.000 女性 26.4 73.6 中心性肥胖 是 13.7 18.7 17.053 0.000 否 86.3 81.3 心脑血管病 是 36.2 42.4 15.253 0.000 否 63.8 57.6 教育水平 文盲/小学 28.9 29.2 0.540 0.763 初中/高中 59.9 60.4 大专及以上 11.2 10.4 个人月收入 低 45.6 48.7 5.275 0.072 中 44.9 43.4 高 9.5 7.9 吸烟情况 现在吸烟 32.2 20.5 70.208 0.000 不吸烟或戒烟 67.8 79.5 现在饮酒 现在饮酒 22.4 15.4 35.422 0.000 不饮酒或戒酒 77.6 84.6 蔬菜摄入(次/周)a < 7 20.1 21.7 6.690 0.035 7~13 15.2 17.9 ≥ 14 64.7 60.4 水果摄入(次/周)a < 7 58.3 55.3 11.106 0.004 7~13 26.4 24.8 ≥ 14 15.3 19.9 体力活动(步/天)b < 4 000 29.3 34.5 10.273 0.006 4 000~7 000 13.2 15.0 > 7 000 57.5 50.5 注:a n = 3 517,b n = 2 284。 表 2 2hPG≤FPG与2hPG > FPG组人群生理指标比较(
$\bar x \pm s$ )生理指标 2hPG ≤ FPG
(n = 1 383)2hPG > FPG
(n = 2 924)t值 P值 年龄(岁) 47.9 ± 0.26 48.9 ± 0.18 9.667 0.000 体质指数(kg/m2) 24.4 ± 0.09 25.0 ± 0.06 28.400 0.000 腰围(cm) 81.9 ± 0.27 82.3 ± 0.19 1.408 0.235 收缩压(mm Hg) 127.9 ± 0.50 128.3 ± 0.34 0.474 0.491 舒张压(mm Hg) 81.5 ± 0.31 82.3 ± 0.22 4.671 0.031 总胆固醇(mmol/L) 5.16 ± 0.03 5.09 ± 0.02 4.987 0.026 甘油三酯(mmol/L) 1.20 ± 0.02 1.24 ± 0.02 1.878 0.171 HDL-C(mmol/L) 1.69 ± 0.01 1.66 ± 0.01 5.007 0.025 FPG(mmol/L) 5.42 ± 0.01 5.18 ± 0.01 0.229 0.000 2 h血糖(mmol/L) 4.68 ± 0.02 6.34 ± 0.01 5 020.500 0.000 胰岛素(pmol/L) 25.8 ± 0.97 26.8 ± 0.61 0.681 0.409 HOMA-IR a 0.90 ± 0.03 0.88 ± 0.02 0.229 0.632 HOMA-β a 42.05 ± 3.24 59.39 ± 2.05 20.421 0.000 注:a n = 2 284。 表 3 多因素非条件logistic回归分析
因素 β $S_{\overline x}$ Wald χ2值 P值 OR值 a 95 % CI a 性别 男性 0.135 0.109 1.524 0.217 1.144 0.924~1.417 女性 0.252 0.107 5.486 0.019 1.286 1.042~1.588 年龄(岁) < 60 0.238 0.084 8.104 0.004 1.268 1.077~1.494 ≥ 60 – 0.050 0.197 0.065 0.799 0.951 0.646~1.400 FPG(mmol/L) < 5.6 0.139 0.098 2.010 0.156 1.149 0.948~1.393 ≥ 5.6 0.260 0.127 4.175 0.041 1.297 1.011~1.665 注:a调整年龄、性别、研究队列、居住地、教育和收入水平、体质指数、甘油三酯、总胆固醇、HDL-C、吸烟和饮酒情况;以2hPG ≤ FPG为参照组。 -
[1] Yang ZJ, Liu J, Ge JP, et al. Prevalence of cardiovascular disease risk factor in the Chinese population: the 2007 – 2008 China National Diabetes and Metabolic Disorders Study[J]. Eur Heart J, 2012, 33(2): 213 – 220. [2] Xu Y, Wang L, He J, et al. Prevalence and control of diabetes in Chinese adults[J]. JAMA, 2013, 310(9): 948 – 959. [3] Sarwar N, Gao P, Seshasai SR, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies[J]. Lancet, 2010, 375(9733): 2215 – 2222. [4] Huang Y, Cai X, Mai W, et al. Association between prediabetes and risk of cardiovascular disease and all cause mortality: systematic review and meta-analysis[J]. BMJ, 2016, 355(1): 5953. [5] DECODE study group. Glucose tolerance and cardiovascular mortality: comparison of fasting and 2-hour diagnostic criteria[J]. Arch Intern Med, 2001, 161(3): 397 – 405. [6] Barr EL, Botko EJ, Zimmet PZ, et al. Continuous relationships between non-diabetic hyperglycaemia and both cardiovascular disease and all-cause mortality: the Australian Diabetes, Obesity, and Lifestyle (AusDiab) study[J]. Diabetologia, 2009, 52(3): 415 – 424. [7] No authors listed. Asymptomatic hyperglycemia and coronary heart disease. A series of papers by the International Collaborative Group, based on studies in fifteen populations. Introduction[J]. J Chronic Dis, 1979, 32(11 – 12): 681 – 837. [8] Bonora E, Kiechl S, Willeit J, et al. Plasma glucose within the normal range is not associated with carotid atherosclerosis: prospective results in subjects with normal glucose tolerance from the Bruneck Study[J]. Diabetes Care, 1999, 22(8): 1339 – 1346. [9] Qiao Q, Jousilahti P, Eriksson J, et al. Predictive properties of impaired glucose tolerance for cardiovascular risk are not explained by the development of overt diabetes during follow-up[J]. Diabetes Care, 2003, 26(10): 2910 – 2914. [10] Ray KK, Seshasai SR, Wijesuriya S, et al. Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomised controlled trials[J]. Lancet, 2009, 373(9677): 1765 – 1772. [11] Levitan EB, Song Y, Ford ES, et al. Is nondiabetic hyperglycemia a risk factor for cardiovascular disease? A meta-analysis of prospective studies[J]. Arch Intern Med, 2004, 164(19): 2147 – 2155. [12] Qiao Q, Pyorala K, Pyorala M, et al. Two-hour glucose is a better risk predictor for incident coronary heart disease and cardiovas-cular mortality than fasting glucose[J]. Eur Heart J, 2002, 23(16): 1267 – 1275. [13] Succurro E, Marini MA, Grembiale A, et al. Differences in cardiovascular risk profile based on relationship between post-load plasma glucose and fasting plasma levels[J]. Diabetes Metab Res Rev, 2009, 25(4): 351 – 356. [14] Abdul-Ghani MA, Williams K, DeFronzo R, et al. Risk of progression to type 2 diabetes based on relationship between postload plasma glucose and fasting plasma glucose[J]. Diabetes Care, 2006, 29(7): 1613 – 1618. [15] Ning F, Zhang L, Dekker JM, et al. Development of coronary heart disease and ischemic stroke in relation to fasting and 2-hour plasma glucose levels in the normal range[J]. Cardiovasc Diabetol, 2012, 11: 76. [16] Ning F, Tuomilehto J, Pyörälä K, et al. Cardiovascular disease mortality in Europeans in relation to fasting and 2-h plasma glucose levels within a normoglycemic range[J]. Diabetes Care, 2010, 33(10): 2211 – 2216. [17] Qiao Q, Pang Z, Gao W, et al. A large-scale diabetes prevention program in real-life settings in Qingdao of China (2006-2012)[J]. Prim Care Diabetes, 2010, 4(2): 99 – 103. [18] Ning F, Pang ZC, Dong YH, et al. Risk factors associated with the dramatic increase in the prevalence of diabetes in the adult Chinese population in Qingdao, China[J]. Diabet Med, 2009, 26(9): 855 – 863. [19] Qie LY, Sun JP, Ning F, et al. Cardiovascular risk profiles in relation to newly diagnosed type 2 diabetes diagnosed by either glucose or HbA1c criteria in Chinese adults in Qingdao,China[J]. Diabet Med, 2014, 31(8): 920 – 926. [20] 中国肥胖问题工作组数据汇总分析协作组. 我国成人体重指数和腰围对相关疾病危险因素异常的预测价值:适宜体重指数和腰围切点的研究[J]. 中华流行病学杂志, 2002, 23(1): 10 – 15. [21] No authors listed. 1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension. Guidelines Subcommittee[J]. Clinical and Experimental Hyperten-sion, 1999, 21(5 – 6): 1009 – 1060. [22] Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man[J]. Diabetologia, 1985, 28(7): 412 – 419. [23] 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2013年版)[J].中国糖尿病杂志, 2014, 22(8):2 – 42. [24] Park C, Guallar E, Linton JA, et al. Fasting glucose level and the risk of incident atherosclerotic cardiovascular diseases[J]. Diabetes Care, 2013, 36(7): 1988 – 1993. [25] Bragg F, Li L, Smith M, et al. Associations of blood glucose and prevalent diabetes with risk of cardiovascular disease in 500 000 adult Chinese: the China Kadoorie Biobank[J]. Diabet Med, 2014, 31(5): 540 – 551. [26] Yang Z, Xing X, Xiao J, et al. Prevalence of cardiovascular disease and risk factors in the Chinese population with impaired glucose regulation: the 2007 – 2008 China national diabetes and metabolic disorders study[J]. Exp Clin Endocrinol Diabetes, 2013, 121(6): 372 – 374. [27] Bragg F, Li L, Bennett D, et al. Association of random plasma glucose levels with the risk for cardiovascular disease among Chinese adults without known diabetes[J]. JAMA Cardiol, 2016, 1(7): 813 – 823. [28] Chien KL, Hsu HC, Su TC, et al. Fasting and postchallenge hyperglycemia and risk of cardiovascular disease in Chinese: the Chin-Shan Community Cardiovascular Cohort study[J]. Am Heart J, 2008, 156(5): 996 – 1002. [29] Chien KL, Lee BC, Lin HJ, et al. Association of fasting and post-prandial hyperglycemia on the risk of cardiovascular and all-cause death among non-diabetic Chinese[J]. Diabetes Res Clin Pract, 2009, 83(2): 47 – 50. [30] Lawes CM, Parag V, Bennett DA, et al. Blood glucose and risk of cardiovascular disease in the Asia Pacific region[J]. Diabetes Care, 2004, 27(12): 2836 – 2842. [31] DeFronzo RA, Ferrannini E, Simonson DC. Fasting hyperglycemia in non-insulin-dependent diabetes mellitus: contributions of excessive hepatic glucose production and impaired tissue glucose uptake[J]. Metabolism, 1989, 38: 387 – 395. [32] Bogardus C, Lillioja S, Howard BV, et al. Relationships between insulin secretion, insulin action, and fasting plasma glucose concentration in nondiabetic and noninsulin-dependent diabetic subjects[J]. J Clin Invest, 1984, 74(4): 1238 – 1246. [33] Wei SH, Lin JD, Hsu CH, et al. Higher normal range of fasting plasma glucose still has a higher risk for metabolic syndrome: a combined cross-sectional and longitudinal study in elderly[J]. Int J Clin Pract, 2015, 69(8): 863 – 870. [34] O′Malley G, Santoro N, Northrup V, et al. High normal fasting glucose level in obese youth: a marker for insulin resistance and beta cell dysregulation[J]. Diabetologia, 2010, 53(6): 1199 – 1209. [35] Piche ME, Lemieux S, Perusse L, et al. High normal 2-hours plasma glucose is associated with insulin sensitivity and secretion that may predispose to type 2 diabetes[J]. Diabetologia, 2005, 48(4): 732 – 740. [36] Lin Z, Zhou J, Li X, et al. High-normal 2h glucose is associated with defects of insulin secretion and predispose to diabetes in Chinese adults[J]. Endocrine, 2015, 48(1): 179 – 186. [37] Stevens JW, Khunti K, Harvey R, et al. Preventing the progression to type 2 diabetes mellitus in adults at high risk: a systematic review and network meta-analysis of lifestyle, pharmacological and surgical interventions[J]. Diabetes Res Clin Pract, 2015, 107(3): 320 – 331. [38] Li G, Zhang P, Wang J, et al. Cardiovascular mortality, all-cause mortality, and diabetes incidence after lifestyle intervention for people with impaired glucose tolerance in the Da Qing Diabetes Prevention Study: a 23-year follow-up study[J]. Lancet Diabetes Endocrinol, 2014, 2(6): 474 – 480.
计量
- 文章访问数: 1425
- HTML全文浏览量: 530
- PDF下载量: 77
- 被引次数: 0