공복혈당 궤적에 따른 심장병 발생 위험: 국민건강보험공단 표본코호트 연구
Fasting Blood Glucose Levels Trajectory and Risk of Cardiovascular Disease in Korean Population: National Health Insurance Service-National Sample Cohort (NHIS-NSC)
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초록
Objectives: To classify trajectories of fasting blood glucose (FBS) levels and examine each trajectory’s associations with risk of cardiovascular disease (CVD). Methods: The National Health Insurance Service-National Sample Cohort (NHIS-NSC) sampled in the 2002 NHIS database was followed until 2010, and 13,829 participants aged 20 years and above had conducted nationwide health examinations annually. We used Cox proportional hazards models to examine the association of trajectories to risk of CVD. Four distinct trajectory groups were identified for FBS: low-stable, moderate-stable, elevated- upward, and High-upward. Results: During 88947.9 person-years of follow-up (mean follow-up, 6.4 years), we documented 2,778 incident case of CVD. Age-standardized incidence rate were increased with FBS levels (5,296.2 in low-stable group, 6,292.6 in moderate-stable group, and 8047.9 in elevated- upward group), but not in High-upward group. In multivariate models adjusted for age and sex, FBS was a significant predictor of CVD in elevatedupward group (hazard ratio (HR)=1.6, 95% confidence interval (CI):1.4-1.8) and High-upward group (HR=1.6, 95% CI:1.3-2.1). However, further adjustment for clinical covariates, only elevated-upward group was significantly associated with CVD (HR=1.2, 95% CI:1.1-1.4). Conclusions: Using the trajectory approach, we found that elevated-upward and High-upward FBS trajectories were associated with greater risk of CVD. These findings indicate the importance of FBS management across the lifespan, prognostic assessments and the targeting of prevention strategies to high-risk individuals.
Abstract
Objectives: To classify trajectories of fasting blood glucose (FBS) levels and examine each trajectory’s associations with risk of cardiovascular disease (CVD). Methods: The National Health Insurance Service-National Sample Cohort (NHIS-NSC) sampled in the 2002 NHIS database was followed until 2010, and 13,829 participants aged 20 years and above had conducted nationwide health examinations annually. We used Cox proportional hazards models to examine the association of trajectories to risk of CVD. Four distinct trajectory groups were identified for FBS: low-stable, moderate-stable, elevated- upward, and High-upward. Results: During 88947.9 person-years of follow-up (mean follow-up, 6.4 years), we documented 2,778 incident case of CVD. Age-standardized incidence rate were increased with FBS levels (5,296.2 in low-stable group, 6,292.6 in moderate-stable group, and 8047.9 in elevated- upward group), but not in High-upward group. In multivariate models adjusted for age and sex, FBS was a significant predictor of CVD in elevatedupward group (hazard ratio (HR)=1.6, 95% confidence interval (CI):1.4-1.8) and High-upward group (HR=1.6, 95% CI:1.3-2.1). However, further adjustment for clinical covariates, only elevated-upward group was significantly associated with CVD (HR=1.2, 95% CI:1.1-1.4). Conclusions: Using the trajectory approach, we found that elevated-upward and High-upward FBS trajectories were associated with greater risk of CVD. These findings indicate the importance of FBS management across the lifespan, prognostic assessments and the targeting of prevention strategies to high-risk individuals.
참고문헌 (34)
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