Comparison of effects of blood pressure, blood glucose and lipid variability on cardiovascular prognosis in diabetic patients

초록

Background and Aims: Metabolic abnormalities such as dyslipidemia, glucose and high blood pressure are common in diabetic patients. Variabilities in these measures have been reported as a potential residual cardiovascular risk factors. This study aimed to analyze the relationship between variabilities of blood pressure, blood glucose, total cholesterol and triglyceride levels (metabolic variability parameters) and their effects on cardiovascular prognosis in diabetic patients. Methods: A total of 24,857 diabetic patients aged 40 years or older who had their blood pressure, blood glucose, total cholesterol, and triglyceride levels measured three or more times for three years after January 1, 2017 at three tertiary general hospitals were selected. They were divided into high/low groups based on their systolic blood pressure (SBP), blood glucose, total cholesterol (TC) and triglyceride coefficient of variation (CV) over a 3-year period. The incidence of major adverse cardiovascular events (MACE), a composite of cardiovascular death, myocardial infarction, and stroke, was compared between groups. Results: The correlation between the CV of SBP and the CV of glucose was highest, and the correlation between the CV of SBP and the CV of triglycerides was the lowest. All groups with high CV had a higher incidence of MACE than those with low CV (table1). Cox regression analysis suggested sex, alcohol, creatinine, SCORE2, SBP CV, TC CV, triglyceride CV, mean TC, and mean glucose as independent risk predictors for MACE in diabetic patients. Conclusions: Metabolic variability parameters, especially SBP CV, TC CV and TG CV, are important residual risk factors for cardiovascular events in diabetic patients.