不同新陈代谢和昼夜节律状态下估计葡萄糖排出率与心血管疾病发病率的关系:一项全国人群前瞻性队列研究的结果。

IF 3.4 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Changwen Le, Yueyue Qin, Zheng Wang, Deqiang Wang, Fangyu Zhong, Shuyin Yang, Jianguang Liu
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引用次数: 0

摘要

背景:最近的研究表明,代谢综合征和昼夜节律综合征与心血管疾病(CVD)的发生密切相关,其中胰岛素抵抗起着重要作用。估计葡萄糖排出率(eGDR)被认为是胰岛素抵抗的可靠替代指标。然而,在不同的代谢和昼夜节律状态下,eGDR与心血管疾病之间的关系尚未得到深入研究,需要大规模的前瞻性队列研究来阐明这种关系:本研究基于中国健康与退休纵向研究(CHARLS),招募年龄在 45 岁及以上、具有完整 eGDR 数据的个体。eGDR 的计算公式为:eGDR(mg/kg/min) = 21.158 - (0.09 × WC) - (3.407 × hypertension) - (0.551 × HbA1c) [WC (cm), hypertension (yes = 1/no = 0), and HbA1c (%)] (Zabala et al. in Cardiovasc Diabetol 20(1):202; 2021)。以 eGDR 最低四分位数(代表胰岛素抵抗程度最高)为参照,计算累积发病率和危险比 (HR) 及 95% 置信区间 (CI)。根据代谢综合征(MetS)或昼夜节律综合征(CircS)的诊断结果,研究人员进一步将参与者分为不同的亚组,以探讨在不同的代谢和昼夜节律条件下,eGDR与心血管疾病之间的关系。采用基于 Cox 回归模型的受限立方样条曲线(RCS)研究了 eGDR 与心血管疾病发病率之间的剂量-反应关系。生成了接收者操作特征曲线(ROC),以评估 eGDR 对心血管疾病发病率的预测价值。此外,还进行了临床决策曲线分析(DCA),以评估基本模型的临床实用性:共纳入 6507 名参与者,中位年龄为 58 岁 [52 岁,64 岁],55% 为女性。中位随访时间为 87 个月,记录了 679 例首次心血管疾病事件,包括心脏病和中风。RCS 曲线显示,在不同的代谢和昼夜节律亚组中,eGDR 与首次出现的心血管疾病发病率之间存在显著的剂量-反应关系(所有 P 值均为 0.05)。eGDR 与所有结果均呈显著的线性关系(非线性 P 结论:eGDR 是心血管疾病风险的独立预测因子,较低的 eGDR 水平与较高的心血管疾病(包括心脏病和中风)风险密切相关。在患有 MetS 或 CircS 的人群中,较低的 eGDR 水平与风险增加之间的关系更为明显。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Association of estimated glucose disposal rate with incident cardiovascular disease under different metabolic and circadian rhythm states: findings from a national population-based prospective cohort study.

Background: Recent studies have shown that both metabolic syndrome and circadian rhythm syndrome are firmly associated with the occurrence of cardiovascular disease (CVD), with insulin resistance playing a significant role. The estimated glucose disposal rate (eGDR) is considered to be a reliable surrogate marker for insulin resistance. However, the relationship between eGDR and CVD under different metabolic and circadian rhythm states has not been thoroughly studied, and large-scale prospective cohort studies are needed to clarify this relationship.

Methods: This study is based on the China Health and Retirement Longitudinal Study (CHARLS), recruiting individuals aged 45 and above with complete eGDR data. The eGDR was calculated by the formula: eGDR(mg/kg/min) = 21.158 - (0.09 × WC) - (3.407 × hypertension) - (0.551 × HbA1c) [WC (cm), hypertension (yes = 1/no = 0), and HbA1c (%)] (Zabala et al. in Cardiovasc Diabetol 20(1):202; 2021).Participants were divided into four subgroups based on the quartiles (Q) of eGDR.The cumulative incidence rates and hazard ratios (HR) with 95% confidence intervals (CI) were calculated, with the lowest eGDR quartile (representing the highest degree of insulin resistance) as the reference. Participants were further divided into subgroups based on the diagnosis of Metabolic syndrome (MetS) or circadian syndrome (CircS) to explore the relationship between eGDR and CVD under different metabolic and circadian rhythm conditions. The dose-response relationship between eGDR and CVD incidence was investigated using a restricted cubic spline (RCS) based on a Cox regression model. Receiver operating characteristic (ROC) curves were generated to assess the predictive value of eGDR for CVD incidence. A clinical decision curve analysis (DCA) was also conducted to assess the clinical utility of the basic model.

Results: 6507 participants were included, with a median age of 58 years [52 years, 64 years], and 55% were female. Over a median follow-up duration of 87 months, 679 first-episode CVD events were recorded, including heart disease and stroke. The RCS curves demonstrated a significant dose-response relationship between eGDR and the incidence of first-presentation CVD in different metabolic and circadian rhythm subgroups (all P-values < 0.001, non-linearity P > 0.05). eGDR exhibited a significant linear relationship with all outcomes (non-linearity P < 0.05). The Kaplan-Meier cumulative incidence curves showed that as eGDR levels increased, the cumulative incidence rates of first CVD, heart disease, and stroke gradually decreased from Q1 to Q4 groups. Significant differences were observed across all metabolic and circadian rhythm subgroups (log-rank test P < 0.001). Through the Cox proportional hazards model, we confirmed a significant association between baseline eGDR levels and first-onset CVD, heart disease, and stroke. Subgroup analyses indicated that the predictive ability of eGDR for CVD risk varied across different Body mass index (BMI) (P for interaction = 0.025) and age (P for interaction = 0.045) subgroups. Mediation analysis revealed that CircS partially mediated this association. Furthermore, time-dependent ROC curves demonstrated the potential of eGDR as a predictor of CVD risk, revealing possible differences in the model's application across different cardiovascular conditions.

Conclusion: eGDR is an independent predictor of CVD risk, with lower eGDR levels being closely associated with a higher risk of CVD (including heart disease and stroke). In populations with MetS or CircS, the association between lower eGDR levels and increased risk is more pronounced.

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来源期刊
Diabetology & Metabolic Syndrome
Diabetology & Metabolic Syndrome ENDOCRINOLOGY & METABOLISM-
CiteScore
6.20
自引率
0.00%
发文量
170
审稿时长
7.5 months
期刊介绍: Diabetology & Metabolic Syndrome publishes articles on all aspects of the pathophysiology of diabetes and metabolic syndrome. By publishing original material exploring any area of laboratory, animal or clinical research into diabetes and metabolic syndrome, the journal offers a high-visibility forum for new insights and discussions into the issues of importance to the relevant community.
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