JGIM：血糖达标非糖尿病患者心血管获益关键

　　一项纳入2.6万余例受试者的观察性研究显示，对于2型糖尿病患者，收缩压（SBP，<130 mm Hg）或低密度脂蛋白胆固醇（LDL-C，<100 mg/dl）达标与心血管疾病（CVD）住院风险的降低显著相关，而糖化血红蛋白（HbA1c）达标（<7%）并不是CVD住院风险降低的独立因素。（J Gen Intern Med. 2013年1月24日在线版）

　　该研究入选26 636例2型糖尿病患者，平均随访5.6年。结果显示，血压、血糖和血脂控制均不达标或仅HbA1c达标者的CVD住院风险最高，年发生率分别为1.82/%和1.69%；三项指标均达标者或SBP和LDL-C两项指标达标者的CVD住院风险最低，年发生率分别为0.72%和0.61%；SBP或LDL-C达标者、HbA1c和SBP均达标者以及HbA1c和LDL-C均达标者的CVD住院风险处于上述两类受试者之间。仅HbA1c达标者的CVD住院风险升高14%，而仅SBP达标或LDL-C达标者的CVD住院风险分别降低37%和48%。

Independent Contribution of A1C, Systolic Blood Pressure, and LDL Cholesterol Control to Risk of Cardiovascular Disease Hospitalizations in Type 2 Diabetes: An Observational Cohort Study

BACKGROUND

Cardiovascular disease (CVD) prevention in diabetes requires broad-based treatment of dyslipidemia, hypertension, and hyperglycemia. The independent contribution of all combinations of risk factor control to CVD risk has not been evaluated.

OBJECTIVE

To estimate the independent association of control of glycosylated hemoglobin (A1C), systolic blood pressure (SBP), and low-density lipoprotein cholesterol (LDL-C) with risk of cardiovascular disease hospitalization.

DESIGN

Non-concurrent longitudinal cohort study.

PATIENTS

The study included 26,636 patients with type 2 diabetes who were members of an integrated group model HMO with multiple A1C, SBP, and LDL-C measurements.

MAIN MEASURES

Patients were followed for a mean (SD) of 5.6 (2.5) years until they died or disenrolled, or until 31 December 2010. The outcome was a first-observed CVD hospitalization. Using the mean of all A1C, SBP, and LDL-C measures during follow-up, we created dichotomous categories of A1C control (< 7 %), SBP control (< 130 mmHg), and LDL-C control (< 100 mg/dL) to estimate the incidence rate of CVD hospitalization associated with all combinations of risk factor control adjusting for demographic and clinical characteristics.

KEY RESULTS

Patients with no controlled risk factors (18.2/1,000 person-years, 95 % CI 16.5−20.2) or with only A1C in control (16.9, 15.0−19.0) had the highest rate of CVD hospitalization, whereas those with all three risk factors controlled (7.2, 6.2−8.4) or with SBP and LDL-C in control (6.1, 5.1−7.2) had the lowest rates. Those with only SBP or LDL-C in control, A1C and SBP controlled, or A1C and LDL-C controlled had statistically similar incidence between the highest and lowest rates.

CONCLUSIONS

Maintaining SBP < 130 mmHg or LDL-C < 100 mg/dL was significantly associated with reduced CVD hospitalization risk, especially when both risk factors were well controlled. Maintaining A1C < 7 % was not independently associated with reduced CVD hospitalization risk.