糖尿病与心脏猝死风险:一项荟萃分析

Diabetes mellitus and the risk of sudden cardiac death:a meta-analysis

目的:分析糖尿病与心脏猝死(SCD)风险的关联,及其影响因素。方法:该研究为Meta分析,是基于Diabetes mellitus and the risk of sudden cardiac death:a systematic review and meta-analysis of prospective studies(简称为原研究)的更新研究。原研究包括了截至2017年在PubMed和Embase上发表的所有满足条件的关于糖尿病与SCD风险关联的病例对照研究和队列研究。该研究在原研究的基础上添加了新发表的研究,即纳入了2023年12月3日前收录于PubMed、Embase以及中国知网(CNKI)、万方医学等数据库的满足条件的研究。中文检索词包括“糖尿病”“葡萄糖”“血糖”“心脏猝死”“心脏骤停”等,英文检索词包括“diabetes”“glucose”“sudden cardiac death”“cardiac arrest”等。提取作为主要结局指标的SCD风险,以及国家、人种、肤色、随访时长、左心室射血分数(LVEF)、基础疾病和其他相关因素。选用相对风险(RR)值作为汇总结果。异质性显著时选用随机效应模型,异质性不显著时选用固定效应模型。采用Cochran′s Q检验进行亚组分析,评估地区、基础疾病、LVEF和人种(基于肤色)等对结局指标的影响。结果:共纳入32项队列/病例对照研究,总样本量为3252954人。Meta分析结果显示糖尿病患者SCD发生风险为非糖尿病人群的2.00倍(RR=2.00,95%CI:1.83~2.19,P<0.001)。亚洲人群糖尿病患者SCD发生风险是非糖尿病人群的1.78倍(RR=1.78,95%CI:1.51~2.10),欧洲为2.05倍(RR=2.05,95%CI:1.79~2.34),美洲为2.12倍(RR=2.12,95%CI:1.82~2.47),组间异质性差异无统计学意义(P=0.287)。基线未合并其他基础疾病的人群中,糖尿病患者SCD发生风险增加1.12倍(RR=2.12,95%CI:1.89~2.38);基线合并冠心病的人群中,糖尿病患者SCD发生风险增加0.75倍(RR=1.75,95%CI:1.45~2.11);基线合并心力衰竭的人群中,糖尿病患者SCD发生风险增加0.92倍(RR=1.92,95%CI:1.51~2.43);基线合并心房颤动的人群,糖尿病患者SCD发生风险增加3倍(RR=4.00,95%CI:1.38~11.56);基线因肾功能衰竭而行血液透析的患者中,糖尿病患者SCD发生风险增加0.76倍(RR=1.76,95%CI:1.25~2.48),组间异质性差异无统计学意义(P=0.262)。在LVEF>50%的心脏病患者中,合并糖尿病者SCD风险增加1.08倍(RR=2.08,95%CI:1.57~2.75);在LVEF<50%的心脏病患者,合并糖尿病者SCD风险增加0.69倍(RR=1.69,95%CI:1.30~2.18),组间异质性差异无统计学意义(P=0.277)。黄种人中糖尿病患者SCD发生风险是健康人的1.80倍(RR=1.80,95%CI:1.73~1.87),白种人中为2.18倍(RR=2.18,95%CI:1.88~2.54),组间异质性差异有统计学意义(P=0.014)。结论:糖尿病可显著增加SCD风险,这种影响在白种人中可能更为明显,而地区、基础疾病、LVEF等并未产生进一步影响。

Objective To assess the association between diabetes mellitus and the risk of sudden cardiac death(SCD),and to identify potential contributing factors.Methods This meta-analysis was an updated version of the original study Diabetes mellitus and the risk of sudden cardiac death:a systematic review and meta-analysis of prospective studies.The original review included all eligible case-control and cohort studies published in PubMed and Embase up to 2017 that investigated the association between diabetes and SCD risk.In this updated study,newly published studies were added,including those available in PubMed,Embase,China National Knowledge Infrastructure(CNKI),and WANFANG MED ONLINE up to December 3,2023.Search terms included"diabetes""glucose""sudden cardiac death""cardiac arrest"and their Chinese equivalent.The primary outcome was the risk of SCD,while factors such as country,ethnicity,skin color,follow-up duration,left ventricular ejection fraction(LVEF),baseline comorbidities,and other relevant variables were analyzed as potential influencing factors.Relative risk(RR)was used as the summary measure.A random-effects model was used when significant heterogeneity was detected,otherwise a fixed-effects model was used.Cochran′s Q test was used for subgroup analysis to assess the influence of factors such as region,baseline diseases,LVEF,and ethnicity(based on skin color)on the outcomes.ResultsA total of 32 cohort/case-control studies with a combined sample size of 3252954 individuals were included.The meta-analysis showed that the risk of SCD in patients with diabetes was double that of non-diabetics(RR=2.00,95%CI:1.83-2.19,P<0.001).In Asian populations,the risk of SCD in diabetic patients was 1.78 times that of non-diabetic individuals(RR=1.78,95%CI:1.51-2.10),2.05 times that of in European populations(RR=2.05,95%CI:1.79-2.34),and 2.12 times that of in American populations(RR=2.12,95%CI:1.82-2.47),with no statistically significant heterogeneity between regions(P=0.287).Among individuals without other baseline comorbidities,the risk of SCD was 2.12 times higher in diabetic patients than in those without diabetes(RR=2.12,95%CI:1.89-2.38).In patients with baseline coronary heart disease,the risk was 1.75 times that of non-diabetics(RR=1.75,95%CI:1.45-2.11).In those with baseline heart failure,the risk was 1.92 times that of non-diabetics(RR=1.92,95%CI:1.51-2.43).In patients with baseline atrial fibrillation,the risk was 4.00 times that of non-diabetic individuals(RR=4.00,95%CI:1.38-11.56).In patients undergoing hemodialysis due to renal failure,the risk was 1.76 times that of non-diabetic individuals(RR=1.76,95%CI:1.25-2.48),with no statistically significant heterogeneity between groups(P=0.262).In cardiac patients with LVEF>50%,the risk of SCD in diabetic patients was 2.08 times that of non-diabetic individuals(RR=2.08,95%CI:1.57-2.75),and in those with LVEF<50%,the risk was 1.69 times that of non-diabetic individuals(RR=1.69,95%CI:1.30-2.18),with no statistically significant heterogeneity between groups(P=0.277).In yellow-skinned populations,the risk of SCD in diabetic patients was 1.80 times that of healthy individuals(RR=1.80,95%CI:1.73-1.87),and in white-skinned populations,it was 2.18 times that of healthy individuals(RR=2.18,95%CI:1.88-2.54),with statistically significant heterogeneity between groups(P=0.014).Conclusion sDiabetes mellitus significantly increased the risk of SCD,and this effect may be more pronounced in white-skinned populations,while region,baseline comorbidities,and LVEF had no further effect.