背景:心血管危险因素控制波动,往往随着时间的推移而改变,并可能受到多因素相互作用的影响。目前,风险因素的存在,而不是它们之间的可变性或相互作用,用于定义处于危险中的人群。2型糖尿病患者危险因素的变异性与心血管发病率和死亡风险之间的关系仍有争议。
方法:使用注册表派生数据,我们确定了29,471名T2D患者,基线无CVD,并至少对风险因素进行了五次测量。每个变量的变异性表示为三年(暴露)期间标准偏差的四分位数。心肌梗塞的发病率,中风,在暴露期后4.80(2.40-6.70)年内评估了全因死亡率.通过采用逐步变量选择的多变量Cox比例风险回归分析,研究了变异性测量与结果发展风险之间的关联。然后,使用递归划分和合并(RECAM)算法探索与结局相关的危险因素变异性之间的相互作用.
结果:HbA1c变异性之间的关联,体重,收缩压,并发现了考虑结果的总胆固醇。在RECPAM确定的6类风险中,与体重和总胆固醇均具有低变异性的患者(1级,参考)相比,体重和血压均具有高变异性的患者具有最高的风险(6级,HR=1.81;95%CI1.61-2.05),尽管在连续访视期间风险因素的平均水平逐渐降低。具有高体重变异性但低-中度收缩压变异性的个体(5级,HR=1.57;95%CI1.28-1.68),中/高体重变异性与高/非常高的HbA1c变异性相关的患者(第4类,HR=1.33;95CI1.20-1.49),具有中等/高体重变异性和低/中等HbA1c变异性的受试者(3类,HR=1.12;95CI1.00-1.25),以及与高/非常高的总胆固醇变异性相关的低体重变异性(2类,HR=1.14;95CI1.00-1.30)也显示事件风险显著增加.
结论:两个危险因素的高变异性,特别是体重和血压,2型糖尿病患者与心血管风险相关。这些发现强调了持续平衡多个风险因素的重要性。
多种危险因素的变异性与2型糖尿病患者心血管事件和死亡率的增加相关。这些变异性彼此相互作用以识别具有事件风险增加的患者类别。体重和收缩压均具有高变异性的患者,尽管危险因素的平均水平逐渐降低,但心血管疾病或死亡的风险最大。体重变异性高但收缩压变异性低的个体,中/高体重变异性与高HbA1c变异性相关的患者,具有中等/高体重变异性和低/中等HbA1c变异性的受试者,以及体重变异性低但总胆固醇变异性高的患者,事件风险也显著增加.
Cardiovascular risk factor control fluctuates, tends to change over time, and is potentially impacted by multifactorial interactions. Currently, the presence of risk factors, rather than their variability or interplay with one another, is taken into account to define the population at risk. The association between variability of risk factors and cardiovascular morbidity and mortality risk among patients with Type 2 diabetes mellitus (T2DM) remains debatable.
Using registry-derived data, we identified 29 471 people with T2DM, without cardiovascular disease (CVD) at baseline, and with at least five measurements of risk factors. Variability for each variable was expressed as quartiles of the standard deviation during 3 years (exposure). The incidence of myocardial infarction, stroke, and all-cause mortality was assessed during 4.80 (2.40-6.70) years following the exposure phase. The association between the measures of variability and the risk of developing the outcome was investigated through multivariable Cox proportional-hazards regression analysis with stepwise variable selection. Then, the recursive partitioning and amalgamation (RECPAM) algorithm was used to explore the interaction among the variability of risk factors associated with the outcome. An association between the variability of HbA1c, body weight, systolic blood pressure, and total cholesterol with the outcome considered was found. Among the six classes of risk identified by RECPAM, patients with a high variability of both body weight and blood pressure had the highest risk [Class 6, hazard ratio (HR) = 1.81; 95% confidence interval (CI) 1.61-2.05] compared with patients with low variability of both body weight and total cholesterol (Class 1, reference), despite a progressive reduction in the mean level of risk factors during successive visits. Individuals with high weight variability but low-moderate systolic blood pressure variability (Class 5, HR = 1.57; 95% CI 1.28-1.68), patients with moderate/high weight variability associated with high/very high HbA1c variability (Class 4, HR = 1.33; 95% CI 1.20-1.49), subjects with moderate/high weight variability and with low/moderate HbA1c variability (Class 3, HR = 1.12; 95% CI 1.00-1.25), as well as those with low weight variability associated with high/very high total cholesterol variability (Class 2, HR = 1.14; 95% CI 1.00-1.30) also showed a significant increase in the risk of an event.
Combined high variability of two risk factors, particularly body weight and blood pressure, is associated with cardiovascular risk among patients with T2DM. These findings highlight the importance of continuous balancing of multiple risk factors.
The variability of multiple risk factors is associated with an increased risk of cardiovascular events and mortality in patients with Type 2 diabetes. These variabilities interact with one another to identify classes of patients with an increased risk of having an event.Patients with a high variability of both body weight and systolic blood pressure had the greatest risk of cardiovascular diseases or mortality despite a progressive reduction in the mean level of risk factors.Individuals with high weight variability but low systolic blood pressure variability, patients with moderate/high weight variability associated with high HbA1c variability, subjects with moderate/high weight variability and with low/moderate HbA1c variability, as well as those with low weight variability but high total cholesterol variability also showed a significant increase in the risk of an event.