Clustering Of Impaired Fasting Glucose With Cardiovascular Risk Factors And Cardio-cerebrovascular Disease

Objective: Cardio-cerebrovascular disease is the leading cause of death in the world,and is also the main cause of life loss in the population.Some studies in recent years suggested that impaired fasting glucose(IFG)may be related to the occurrence of cardio-cerebrovascular disease.At present,the results of studies on the effects of impaired fasting glucose on cardio-cerebrovascular disease are still controversial.In addition,many people with impaired fasting glucose also suffer from hypertension,dyslipidemia,and central obesity.It is not established whether the combination of impaired fasting glucose with traditional risk factors can increase the risk of coronary heart disease and stroke.Moreover,the impact of clustering of risk factors on the prevalence of cardio-cerebrovascular disease,and to what extend,the disease can be attributed to a certain risk factor also need further exploration.The purpose of this study is to solve the above questions through a large sample survey,and to provide valuable information for the prevention and treatment of cardio-cerebrovascular disease in the future.Methods:1.Study subjectsSubjects were collected in the National High-tech district,Suzhou,China from March 2016 to April 2016.This study adopted a method of random cluster sampling,approximately 1/20 buildings were sampled from 42 communities on the cluster sampling.All the residents aged?18 years living in the selected buildings were invited to participate in the study.All participants signed the written informed contents and the performed procedures of the study met ethical requirements.2.Contents and methods of investigationThe data were collected by trained staff with a face to face interview using a standardized questionnaire including demographic characteristics,disease and lifestylehistory,then physical examination and laboratory test were conducted all participants.Fasting blood samples were collected in the morning after at least 8h of fasting for all participants.Serum was subsequently isolated from the whole blood,and all serum samples were frozen at-80℃ until testing the biochemical indicators.3.Statistical analysisIn this study,Epidata 3.1 software was used to establish a database.The questionnaire was entered and checked by two professionals.Statistical analysis was conducted using SAS(version 9.4)statistical software.All P values were based on a2-sided test and a significance level of 0.05.The unconditional Logistic regression model was fitted to analyze the relationship between the cardio-cerebrovascular disease and IFG,with the OR and 95% CI calculated.Participants were stratified according to whether the subject suffered from hypertension,dyslipidemia,or central obesity and the relationship were calculated between IFG and the cardio-cerebrovascular disease under different blood pressure,blood lipids,and different waistline status.Unconditional Logistic regression model was used to analyze the association between cardio-cerebrovascular disease and IFG combining with hypertension,dyslipidemia or central obesity.The Cochran-Armitage trend test was used to analyze the relationship between prevalence of cardio-cerebrovascular disease and the number of risk factor clustering.Receiver operating characteristic curve(ROC)was used to calculate the area under the curve(AUC)and the 95% confidence interval(CI)of IFG and fasting plasma glucose(continuous)for cardio-cerebrovascular disease.Net reclassification improvement(NRI)and integrated discrimination improvement(IDI)were calculated to assess the predictive value of impaired fasting glucose and fasting glucose(continuous)on cardio-cerebrovascular disease on the basis of traditional cardiovascular risk factors.In addition,we tried to find out which risk factor combining with IFG had a more predictive value on the cardio-cerebrovascular disease.We combined any one or two of cardiovascular risk factors with IFG,and calculated the AUC and 95% CI of all combinationsand compared with each other.Finally,we calculated the population attributable risk percent(PAR%)of the risk factors(IFG,hypertension,dyslipidemia and central obesity)contributed to for cardio-cerebrovascular disease.In the general population,male and female populations,PAR% of cardio-cerebrovascular disease with IFG,hypertension,dyslipidemia and central obesity were computed by the straightforward method.Results:1.In this study,8538 non-diabetes subjects were included in the analysis.The median age of subjects was 56.96 years old.There were 3499 men(40.8%)and5069women(59.2%).Of all participants,7771(90.70%)were normoglycemic and 797(9.30%)were IFG patients.There were 280 patients with cardio-cerebrovascular disease,the prevalence was 3.3%(standardized prevalence: 2.7%),including 158 isolated coronary heart disease events(prevalence: 1.84%,standardized prevalence: 1.51%),105 isolated stroke events(prevalence: 1.23%,standardized prevalence: 0.97%)and 17 CHD combined stroke events(prevalence: 0.20%,standardized prevalence: 0.17%).2.The analysis of IFG,hypertension,dyslipidemia,central obesity,associated with cardio-cerebrovascular disease showed that the OR of each risk factor was statistically significant in the univariate analysis.After adjusting for multiple factors,IFG and hypertension were still significantly associated with cardio-cerebrovascular disease,their ORs and 95%CIs were 1.62(1.18-2.22)and 2.37(1.77-3.19)respectively.In addition,IFG and hypertension also increased the risk of coronary heart disease after adjustment,their ORs and 95%CIs were 2.09(1.44-3.02)and 1.81(1.26-2.58).However,in the analysis of the relationship between cardiovascular risk factors and stroke,only hypertension had a statistical significance,and the risk of stroke in hypertension patients was as 3.13(1.95-5.01)times as that in non-hypertension participants.3.Subgroup analysis showed that IFG was associated with cardio-cerebrovascular disease in both hypertensives(OR=1.51,95%CI:1.06-2.17)and non-hypertensives(OR=1.99,95%CI: 1.04-3.80).In the dyslipidemia group,the risk of cardio-cerebrovascular disease in IFG patients was as 1.78 times as that in normal blood glucose group.And in the normal lipid group,the adjusted OR was not statistically significant.In the central obesity group,the risk of cardio-cerebrovascular disease in IFG patients was as 1.72 times as that in normal blood glucose group.In the normal waistline group,the multivariate adjusted OR was not statistically significant.4.The prevalence of cardio-cerebrovascular disease among participants without IFG and without risk factors(risk factors: hypertension,dyslipidemia and central obesity),among isolated IFG patients,and among participants with the coexistence of IFG and 1,2,3 risk factors were 0.87%,2.25%,4.37%,8.13% and 9.89%,respectively.The results of the Cochran-Armitage trend test showed the prevalence of cardiovascular disease increased with the increase of risk factor numbers(P for trend <0.0001).In the subsequent Logistic regression analysis,ORs of cardio-cerebrovascular disease for participants with IFG,the coexistence of IFG with 1,2 and 3 cardiovascular risk factor were significant,which were 1.56(0.35-6.96)2.51(1.09-5.80),4.86(2.57-9.17)and5.73(2.85-11.52).5.IFG has a predictive effect on coronary heart disease and cardio-cerebrovascular disease.The AUC was 0.572 and 0.554,respectively.The AUC for predicting stroke was not statistically significant at a level of 0.05.6.IFG combining with any cardiovascular traditional risk factors(including hypertension,dyslipidemia,and central obesity)could predict the prevalence of cardio-cerebrovascular disease(all P values were less than 0.0001).The IFG+hypertension group had the best predictive ability for cardio-cerebrovascular disease,the AUC and 95% CI were 0.7132(0.6860-0.7404),which was significantly higher than the other two groups(all P<0.0001).IFG combining with any two traditional cardiovascular risk factors also had the role of predicting cardio-cerebrovascular disease(all P values were less than 0.0001),and the IFG+ hypertension + dyslipidemia group was the best predictor for cardio-cerebrovascular disease,it’s AUC and 95%CI were0.7229(0.6954-0.7503).7.The population-attributable risk percent of IFG and hypertension to cardio-cerebrovascular disease was statistically significant.The PAR% and 95%CI after multivariate adjustment were 7.67%(2.15%-13.19%)and 42.88%(31.00%-54.77%),respectively.And the combined PAR% of IFG,hypertension,dyslipidemia and central obesity was 56.83%(58.98% in men and 54.10% in women).Conclusion:1.IFG is an independent risk factor for cardio-cerebrovascular disease.Particularly,it is closely associated with coronary heart disease.2.Clustering of IFG with multiple risk factors will increase the risk of cardio-cerebrovascular disease,and the more risk factors are clustered,the higher the risk of cardio-cerebrovascular disease is.3.IFG can increase the predictive ability of cardio-cerebrovascular disease on the basis of traditional cardiovascular risk factors.Among all combinations of risk factors,the clusting of IFG and hypertension has the highest predictive value for cardio-cerebrovascular disease.4.7.67% of cardio-cerebrovascular disease can be attributed to IFG,early detection and effective intervention before IFG progresses to diabetes can reduce the burden of cardio-cerebrovascular disease by approximately 8%.