Background: Studies have reported an association between prevalent cardiovascular disease (CVD) and risk of diabetes mellitus (DM). However, factors that may explain the association remain unclear. We examined the association of prevalent CVD with incident DM and assessed whether weight gain and medication use may explain the association.
Methods: Data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Visit 1 (2008-2011) and Visit 2 (2014-2017) were used to compare incidence of DM among individuals with and without self-reported CVD at Visit 1. A total of 1899 individuals with self-reported CVD were matched to controls free of self-reported CVD at Visit 1 using 1:1 propensity score matching. Covariates included in the propensity model were sociodemographic characteristics, lifestyle factors, comorbid conditions, and study site. The effect of self-reported CVD on incident DM was examined using a generalized estimating equation. The mediating effects of weight gain and use of cardiovascular medications were evaluated.
Results: Covariate distributions were similar among individuals with and without self-reported CVD. The incidence of DM among persons with self-reported CVD was 15.3% vs 12.7% among those without self-reported CVD. Compared to individuals without self-reported CVD, individuals with self-reported CVD had a 24% increased risk for incident DM (odds ratio = 1.24, 95% confidence interval = 1.01, 1.51). The association between self-reported CVD and DM was mediated by the use of beta-blockers (proportion explained = 25.4%), statins (proportion explained = 18%), and diuretics (proportion explained = 8%). We found that weight gain did not explain the observed association.
Conclusions: Prevalent cardiovascular disease was associated with a significant increased risk of incident diabetes. The observed association was partially explained by some medications used to manage CVD.
背景: 已有研究报道流行的心血管疾病(CVD)与糖尿病(DM)风险之间存在关联。然而, 可能解释这种联系的因素仍不清楚。我们分析了流行的心血管疾病与糖尿病发病的关系, 并评估了体重增加和药物使用是否可以解释这种联系。 方法: 使用西班牙裔社区健康研究/拉丁裔研究(HCHS/SOL) 2008-2011及2014-2017的数据, 比较前者中有和没有自我报告心血管疾病个体的糖尿病发病率。共有1899名自我报告心血管疾病的患者, 采用1:1倾向得分匹配的方法与无自我报告心血管疾病的对照组进行配对。倾向性模型中的协变量包括社会人口学特征, 生活方式因素, 并发症情况和研究地点。使用通用的估计方程来检验自我报告的心血管疾病对糖尿病的影响。评估体重增加和心血管药物使用的中介作用。 结果: 在有和没有自我报告的心血管疾病的个体中, 协变量分布是相似的。自报心血管病患者的糖尿病发病率为15.3%, 非自报心血管病患者的糖尿病发病率为12.7%。与没有自我报告心血管疾病的个体相比, 有自我报告心血管疾病的个体发生糖尿病的风险增加24%(优势比=1.24, 95%可信区间=1.01, 1.51)。自我报告的心血管疾病和糖尿病之间的联系是通过使用β-受体阻滞剂(解释比例=25.4%), 他汀类药物(解释比例=18%)和利尿剂(解释比例=8%)来调节的。我们发现体重增加并不能解释观察到的关联。 结论: 常见的心血管疾病与糖尿病发病风险显著增加相关。一些用于治疗心血管疾病的药物部分解释了观察到的关联。.
Keywords: cardiovascular disease; cardiovascular medications; incident diabetes; mediation; propensity scores; 倾向得分; 心血管疾病; 心血管药物; 糖尿病事件; 调解.
© 2021 The Authors. Journal of Diabetes published by Ruijin Hospital, Shanghai JiaoTong University School of Medicine and John Wiley & Sons Australia, Ltd.