A Cohort Study Of Diabetes Mellitus With Hypertension And Cardiovascular Disease Risk

Objective To investigate the prevalence of related cardiovascular diseases（CVD）in diabetic（DM）and hypertension（HTN）population and their relationship with CVD.To analyze the influencing factors of CVD in diabetic patients with hypertension（DM-HTN）and explore the risk of CVD and the relationship between blood pressure and CVD in DM-HTN population,and to provide intervention guidance for the prevention of CVD in DM-HTN population.Methods This study involved two parts.First,the cross-sectional study was based on the baseline DM and HTN patients with different disease types in Jinchang cohort from June 2011 to December 2013 to describe the prevalence of each group and CVD.After controlling for age,obesity,overweight,smoking and other covariates with the unconditional Logistic regression model,the OR values of each group were compared to analyze the relationship between DM,HTN and related CVD,and the influencing factors of CVD in the DM-HTN patients were analyzed with the model.Second,the prospective study was based on the first follow-up survey from January 2014 to December 2015,DM-HTN patients were selected as the exposure group and those without DM or HTN as the non-exposure group,and a 1:1 individual matching cohort was formed by propensity score matching method,Kaplan-Meier curves of related CVD endpoints were established and matched Cox regression analyses were performed to evaluate the causal relationship between DM-HTN and CVD.Subgroup analyses were performed on the matched cohort to estimate the homogenous association.In addition,multivariate adjusted Cox regression models were used to analyze the risk of CVD with different blood pressure in DM-HTN patients,and dose-response relationships were analyzed by restricted cubic splines.Results 1.The prevalence rates of only DM,only HTN,and DM-HTN in the baseline population of the cohort were 2.98%,24.90%,and 5.05%,respectively.The prevalence of HTN in DM population was 62.71%,and the prevalence of DM in HTN population was 16.77%.The prevalence of HTN was higher in males and the elderly.The related risk factors of CVD,such as age,overweight and obesity rate,hyperlipidemia,were higher in DM-HTN group than in control group.The prevalence of CHD,CVA and CVD in DM-HTN group were 10.44%,7.21%and 16.13%,respectively,which were higher than those in the other three groups.2.After adjusting for age,gender and other factors in the DM-HTN population,the risk of CHD in the DM-HTN population was 122%higher than that in the control group,the OR（95%CI）of males and females was 2.20（1.59～3.03）and 2.30（1.51～3.52）,respectively.The risk of CVA increased by 462%,with OR（95%CI）of 6.01（3.97～9.10）for males and 4.83（2.61～8.93）for females.The risk of CVD increased by 198%,with OR（95%CI）of 3.26（2.48～4.28）for males and2.56（1.76～3.73）for females.3.In the baseline 2040 DM-HTN population,risk factors for CHD were≥60 years of age,hyperlipidemia,family history of CVD and HTN;Risk factors for CVA included≥60 years of age,HTN family history,abstinence from alcohol,while regular drinking and physical exercise were protective factors;Risk factors for CVD included≥60 years of age,hyperlipidemia,family history of CVD and HTN,while regular drinking and exercise were protective factors.4.The cohort study followed 1157 DM-HTN patients,the incidence rates of CHD,CVA,and CVD were 14.01,9.51,and 23.48 per thousand years,respectively,and a 1:1 PSM was performed with baseline non-DM-HTN subjects,and 1116 pairs of subjects were finally matched.After matching,the risk of CHD,CVA and CVD in the DM-HTN group was 2.01 times,2.54 times and2.18 times of that in the control group,respectively.DM-HTN and related CVD subgroup analysis results showed that:Among non-tea drinkers,the risk of CHD in DM-HTN group was 5 times higher than that in the control group;the risk of CVA in the overweight group was 4.69 times higher than that in the control group;the risk of CVD in female and male DM-HTN groups was 6.50 and 1.71times higher than that in the control group,respectively.5.After adjusting the age,gender,education level and other factors of the DM-HTN population,the risk of CVD with different ranges of systolic blood pressure（SBP）and diastolic blood pressure（DBP）was slightly different.Compared with reference group SBP（130～139mm Hg）,when SBP<120mm Hg,the risk of CHD was higher with HR（95%CI）:6.50（1.72～24.59）,males were consistent with the general population,after age stratification,both SBP<120mm Hg and SBP≥140mm Hg were at higher risk compared with the reference group,but remained statistically significant.The risk of CVD in different SBP ranges was similar to that of CHD.Restricted cubic spline（RCS）analysis showed that there was a J-shaped association between SBP and CHD,but no dose-response relationship,and there was still a J-type nonlinear correlation between SBP and CHD in the male group(P<0.001,P_nonlinear<0.001).The J-shaped curve of DBP and CHD was not obvious,but showed a linear dose-response relationship(P<0.05,P_nonlinear>0.05).The dose-response relationship between SBP,DBP and CVA was not statistically significant,but there was a non-linear dose-response relationship with the CVD(P<0.05,P_nonlinear<0.05),especially the J-shaped association of DBP was more significant.Conclusions 1.The prevalence of HTN in DM patients was high;The prevalence of DM-HTN was relatively high,especially in men and the elderly.Patients with DM-HTN were at high risk of CHD,CVA and CVD,especially in the elderly.Risk factors for CVD in DM-HTN patients included≥60 years of age,hyperlipidemia,family history of CVD and HTN.Regular drinking and exercise were protective factors.2.DM-HTN was an independent risk factor for CHD,CVA and CVD.3.SBP and CHD in patients with DM-HTN showed a J-type association,which was more significant in men and patients under 60 years of age;blood pressure and CVA had no J-type association;DBP and CVD showed a J-type association.