糖化血红蛋白测量和预测心血管疾病
, Emanuele Di Angelantonio1, Pei Gao1
1University of Cambridge, Cambridge, United Kingdom.
JAMA
|March 27, 2014
概括
测量糖化血红蛋白 (HbA1c) 在预测没有糖尿病的个人心血管疾病 (CVD) 风险方面提供了最小的额外益处. 这一发现表明,目前的风险因素在很大程度上足以预测心血管疾病事件.
科学领域:
- 心脏病学 心脏病学
- 内分泌学 在内分泌学.
- 预防医学 预防医学
背景情况:
- 糖化血红蛋白 (HbA1c) 对初始心血管事件的预测值尚未得到充分确立.
- 传统的心血管风险因素用于估计一个人患心血管疾病 (CVD) 的风险.
研究的目的:
- 评估是否将HbA1c测量纳入现有的心血管风险评估模型可以改善心血管疾病风险的预测.
- 为了确定HbA1c测试对心血管事件预测的增量效益.
主要方法:
- 分析来自73项前性研究的个人参与者数据,包括294,998名没有糖尿病或心血管疾病的参与者.
- 使用C指数评估风险歧视,使用10年CVD风险类别净重新分类改进进行重新分类.
主要成果:
- 在HbA1c水平和心血管疾病风险之间观察到大约J形的关联,在调整脂质或功能后略有变化.
- 将HbA1c添加到传统的风险因素中,导致C指数略有增加 (0.0018) 和净重新分类改进 (0.42).
- 与禁食,随机或负载后血糖测量相比,HbA1c提供了类似或更好的预测性改善.
结论:
- 在没有被诊断为心血管疾病或糖尿病的个体中,测量HbA1c为预测未来心血管事件提供了很少的附加值.
- 目前的结合常规因素的心血管风险评估模型似乎在很大程度上足以进行风险分层.
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