空腹血糖受损新标准对其患病率和缺血性心血管病发病危险的影响

Impact of new criterion of glucose level on the prevalence of impaired fasting glucose and risk of ischemic cardiovascular diseases

目的评价2003年美国糖尿病协会新的空腹血糖受损标准对中国35～64岁人群空腹血糖受损率的影响以及与缺血性心血管病发病危险的关系。方法以中国多省市前瞻性队列研究的数据为基础,对30 378人基线血糖水平的分布特点以及10年随访期间发生的缺血性心血管病(包括冠心病和缺血性脑卒中)事件关系进行分析。结果 (1)依据新的空腹血糖受损的标准,我国35～64岁人群空腹血糖受损率从6.9%上升到21.6%,增加了2.1倍;(2)按基线血糖水平分为4个亚组,随着血糖水平的升高,其他传统心血管病危险因素的比例增加;(3)缺血性心血管病人年发病率和血糖单因素分析显示,随着血糖水平的增加男女两性缺血性心血管病发病危险增加,并达到统计学意义;(4)多因素分析显示,在调整了其他传统的心血管病危险因素后,空腹血糖受损新的标准(由6.11mmol/L 降为<5.55 mmol/L)对男性缺血性心血管病有独立的影响作用(RR=1.302,95% CI=1.021～1.660);对女性缺血性心血管病发病危险缺乏独立的影响作用(RR=1.255,95% CI=0.887～1.776)。结论依据新标准中国35～64岁人群空腹血糖受损率增加了2倍以上。随着血糖水平的增加伴有其他传统的危险因素的比例及缺血性心血管病的人年发病率增加,多因素分析后空腹血糖受损新切点增加男性缺血性心血管病发病的危险。

Objective To evaluate the effect of lowering the fasting plasma glucose （FPG） cutoff point for the criterion of impaired fasting glucose （IFG） in the 2003 ADA guideline on the prevalence of IFG and risk of iachemic cardiovascular diseases （ICVD） associated with IFG in Chinese population. Method A prospective study was carried out in 11 provinces from 1992 to 2003. The baseline survey was conducted according to the WHO-MONICA protocol for risk factor surveys . These subjects have been followed-up for coronary heart disease （CHD） and stroke since the baseline survey. The association between baseline FPG and ICVD （CHD and ischemic stroke） events in 30 378 subjects aged 35-64 years in the lO-year follow-up period was analyzed. Results （ 1 ） Lowering the criterion for diagnosing IFG to 5.55 mmol/L increased the prevalence of IFG from 6. 9% to 21.6% in Chinese population aged 35-64 years. （2） As compared with the group of FIG less than 5.55 mmol/L , the prevalence of other traditional CVD risk factors increased in the FPG level of 5.55-6.05, 6. 11-6.94 and 6.99 mmol/L or above. （3） Univariate analysis method showed that the 10-year accumulated incidence and relative risk for ICVD increased with the elevated baseline level of FPG. （4） After adjusting for age and other ICVD risk factors （including hypertension, lipid disorder, smoking and obesity） FPG level of 5.55-6. 05 mmol/L showed an independently predictive value for ICVD in men （RR = 1. 302,95% CI = 1. 021-1. 660）, but not in women （ RR = 1. 255,95% CI = O. 887-1. 776）. Hypertension, low HDL-C, smoking （men） and central obesity （women） were more strongly associated with ICVD than glucose status. Conclusions The newly defined IFG criterion （ FPG 5.55-6. 94 mmol/L） increased the prevalence of IFG by more than 2 times in Chinese population aged 35-64 years. The 10-year accumulated incidence and relative risk for ICVD increased with the elevated baseline level of FPG. The predictive value of hyperglycemia for ICVD was weaker than that of other traditional risk factors. Comprehensive intervention for multiple risk factors clustering should be strengthened to reduce the overall risk of CVD.