使用重复测量来预测2型糖尿病患者心血管风险
Krishna M Gokhale1, Joht Singh Chandan1, Chris Sainsbury1
1University of Birmingham, Birmingham, United Kingdom.
The American journal of cardiology
|November 4, 2024
概括
使用重复措施优化2型糖尿病 (T2DM) 患者的心血管疾病 (CVD) 风险预测,只显示了轻微的改善. 需要进一步的研究来提高T2DM目前的CVD风险模型的准确性.
科学领域:
- 心脏病学 心脏病学
- 糖尿病学 糖尿病学
- 流行病学 流行病学
背景情况:
- QRISK心血管疾病 (CVD) 风险评估模型需要针对2型糖尿病 (T2DM) 患者进行优化.
- 对T2DM患者的大量,重复测量的数据可能会提高心血管疾病风险预测.
- 准确的心血管疾病风险评估对于指导T2DM的预防策略至关重要.
研究的目的:
- 评估是否结合时间变化,重复测量数据可以提高QRISK模型对T2DM患者心血管疾病的预测能力.
- 通过使用英国大型初级保健数据库,评估增强的QRISK模型的性能.
主要方法:
- 在IQVIA医学研究数据英国数据库中,从IQVIA医学研究数据英国数据库中确定了一组198,835名T2DM患者 (25-85岁) 没有先前使用心血管疾病或他类药物.
- 用一个具有时间依赖的协变量的考克斯危险模型来估计心血管疾病风险,并结合了传统和非传统因素.
- 模型的性能使用歧视 (哈雷尔的C指数) 和对男性和女性子组的校准统计数据进行了验证.
主要成果:
- 与标准QRISK模型相比,包括时间变化的重复测量只显示了T2DM患者心血管疾病风险预测的边际改善.
- 哈雷尔的女性和男性模型的C指数分别为0.71和0.69,表明预测性能中等.
- 预测和观察到的生存概率在两种性别中都非常一致,这表明合理的模型校准.
结论:
- 当前的时间变化数据,当添加到QRISK模型时,为T2DM患者的CVD风险预测提供了有限的增强.
- 对额外的共变量和先进的建模技术进行进一步的研究是有必要的,以提高在这个人群中CVD风险预测的准确性.
- 加强心血管疾病风险分层对于2型糖尿病患者有效的初级预防至关重要.
相关概念视频
Diabetes Mellitus: Type 2 and Gestational
2.2K
Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...
2.2K
Carbohydrate Metabolism
10.8K
Carbohydrates are polymers composed of molecules containing atoms of carbon, hydrogen and oxygen. One gram of carbohydrate can provide four kilo-calories of energy, which makes it the most efficient instant energy source.
Starch accounts for approximately 60% of the carbohydrates consumed by humans. Since amylase enzymes cannot function in the stomach's acidic environment, starch can only be digested in the mouth and small intestine. Simple sugars are found naturally in milk and fruits in...
Starch accounts for approximately 60% of the carbohydrates consumed by humans. Since amylase enzymes cannot function in the stomach's acidic environment, starch can only be digested in the mouth and small intestine. Simple sugars are found naturally in milk and fruits in...
10.8K
Assessment of the Cardiovascular System I: Subjective Data
280
A thorough health history and physical assessment are essential for identifying cardiovascular disease (CVD) symptoms and distinguishing them from other health issues.
Initial Enquiry
Ask the patient about their primary concern and thoroughly explore all reported symptoms.
Medical History
Investigate past illnesses affecting the cardiovascular system, such as angina, anemia, rheumatic fever, congenital heart disease, stroke, thrombophlebitis, dysrhythmias, varicosities
Inquire about symptoms...
Initial Enquiry
Ask the patient about their primary concern and thoroughly explore all reported symptoms.
Medical History
Investigate past illnesses affecting the cardiovascular system, such as angina, anemia, rheumatic fever, congenital heart disease, stroke, thrombophlebitis, dysrhythmias, varicosities
Inquire about symptoms...
280
Errors occurring during blood pressure monitoring
605
Blood pressure monitoring is a crucial clinical procedure in diagnosing and managing various cardiovascular conditions. Despite its significance, the accuracy of blood pressure measurements can be compromised by multiple factors, potentially leading to either falsely high or low readings. These inaccuracies are critical as they can significantly impact patient care. So, it is vital to understand these challenges deeply and adopt strategic approaches to minimize errors.
Several factors...
Several factors...
605
Assessment of blood pressure in brachial artery(two-step method)
658
Measuring blood pressure is a fundamental skill in healthcare that aids in diagnosing and monitoring hypertension and other cardiovascular conditions. An aneroid sphygmomanometer, commonly used in clinical settings, offers a manual and precise method for blood pressure measurement. The technique for using this instrument involves specific steps that must be carefully executed to ensure accuracy. The following detailed description outlines a two-step technique for assessing blood pressure using...
658
Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
61
Cardiac biomarkers are critical in diagnosing, prognosing, and managing cardiovascular diseases. Routine measurement of specific biomarkers such as B-type natriuretic peptide (BNP), C-reactive protein (CRP), and homocysteine (Hcy) is common practice in clinical settings to evaluate heart function and predict cardiovascular events.
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
61


