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Int J Epidemiol:2型糖尿病患者心血管风险预测的危险因素变异性增量值

2022-07-13 网络 网络

在早期阶段确定那些心血管疾病风险最高的人是预防心血管疾病的基础。

背景:心血管疾病(CVD)是2型糖尿病患者死亡或残疾的主要原因,成人2型糖尿病患者发生心血管疾病的风险大约是其他已确定的心血管疾病风险因素的2倍。在早期阶段确定那些心血管疾病风险最高的人是预防心血管疾病的基础。此外,心血管疾病风险评估对于指导加强干预和制定2型糖尿病患者的血压、血脂和血糖的治疗目标非常重要。已经开发了专门用于2型糖尿病患者的心血管疾病风险预测模型,并在几个国家指南中推荐临床使用。然而,大多数模型使用单一风险预测指标,只有少数[例如,英国前瞻性糖尿病研究(UKPDS)]通过使用手段纳入重复测量。此外,风险因素[如收缩压(SBP)、胆固醇、糖化血红蛋白(HbA1c)]的变异性增加与心血管疾病风险增加相关,独立于因素本身,可被视为风险评估模型中的附加组成部分。需要研究利用纵向数据中危险因素的变异性来预测2型糖尿病患者心血管疾病风险的潜在收益。使用电子健康记录(EHR)进行心血管疾病风险评估和随后的个性化医疗决策的好处得到了很好的认识。由于例行健康评估的频率高于普通人群,这种好处在糖尿病人群中可能更大。

目的:这项研究的目的是评估与标准模型相比,利用具有人群代表性的大型EHR数据库中重复测量的预测因子的人内变异性是否可以为2型糖尿病患者的心血管风险预测提供额外的价值。

方法:我们使用了来自英国临床实践研究数据链的2004年至2017年83910名患有2型糖尿病但没有既往心血管疾病的成年人的电子健康记录(EHR)数据。使用里程碑式的建模方法,我们开发并验证了性别特异性COX模型,纳入了传统的预测因子和轨迹,以及收缩压(SBP)、总和高密度脂蛋白胆固醇(HDLc)以及糖化血红蛋白(HbA1c)的变异性。使用单一的最后观察值或均值将这些模型与更简单的模型进行比较。

结果:SBP、高密度脂蛋白胆固醇、糖化血红蛋白的标准差与心血管风险显著相关(P<0.05)。与使用上次观察值(C指数=0.651,95%CI:0.646-0.656)或均值(C指数=0.650,95%CI:0.645-0.655)相比,结合连续预测因子的轨迹和可变性的模型显示出更好的风险辨别能力(C指数=0.659,95%CI:0.654-0.663)。与包括总胆固醇(C指数增加=0.002,95%CI:0.000-0.003)、HbA1c(C指数增加=0.002,95%CI:0.000-0.003)或高密度脂蛋白(C指数增加=0.003,95%CI:0.002-0.005)的SD相比,包含SBP的SDS在辨别力方面的改善最大(C指数增加?0.005,95%CI:0.004-0.007)。

表1 2004-2017年,英国英格兰,临床实践研究数据链,医院流行病学统计和国家统计局验证数据集中用于预测2型糖尿病患者心血管疾病风险的C指数和Brier评分(随变化)

图12004-2017年间,至少有两次重复测量收缩压(SBP)、总胆固醇、高密度脂蛋白胆固醇和糖化血红蛋白(HbA1c)的人的验证数据集中模型之间心血管疾病风险区分的变化

结论:纳入EHR预测因子的变异性可适度改善2型糖尿病患者的心血管风险识别能力。鉴于EHR特别是定期监测的糖尿病患者可以随时采取重复措施,这种改善很容易实现。

原文出处:Xu Z,  Arnold M,  Sun L,et al.Incremental value of risk factor variability for cardiovascular risk prediction in individuals with type 2 diabetes: results from UK primary care electronic health records.Int J Epidemiol 2022 Jul 01

 

 

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ADM是一种52个氨基酸的肽,属于降钙素基因相关肽家族,是一种血管扩张剂。ADM由多种不同的细胞分泌,包括血管内皮细胞、平滑肌细胞、外膜成纤维细胞以及脂肪细胞。

Cardiovasc Diabetol:在2型糖尿病中,AGEs和可溶性RAGE亚型的循环水平与全因死亡率和心血管并发症的发生有关

AGEs是蛋白质和脂质的非酶糖基化和氧化的产物,在生理条件下,抗糖基化防御足以防止其积累。

MOVEMENT DISORDERS:2型糖尿病与帕金森病更快进展有关

T2DM与帕金森病更快的疾病进展有关,它可能是缓解帕金森症状和减缓残疾和痴呆进展的目标。

Cardiovasc Diabetol:血管活性肽ET-1和ADM与糖尿病风险的相关性

高水平的CT-proET-1和MR-proADM与2型糖尿病风险相关

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