Progression from different blood glucose states to cardiovascular diseases: a prospective study based on multi-state model.

Abstract

To quantify the trajectories from normoglycaemia to prediabetes, subsequently to type 2 diabetes (T2DM), cardiovascular diseases (CVD), and cardiovascular death, and the effects of risk factors on the rates of transition. We used data from the Jinchang cohort of 42,585 adults aged 20-88 free of coronary heart disease (CHD) and stroke at baseline. A multistate model was applied for analyzing the progression of CVD and its relation to various risk factors. During a median follow-up of 7 years, 7,498 participants developed prediabetes, 2,307 developed T2DM, 2,499 developed CVD, and 324 died from CVD. Among 15 postulated transitions, transition from comorbid CHD and stroke to cardiovascular death had the highest rate (157.21/1000 person-years), followed by transition from stroke alone to cardiovascular death (69.31/1000 person-years.), and transition from prediabetes to normoglycaemia (46.51/1000 person-years). Prediabetes had a sojourn time of 6.77 years, and controlling weight, blood lipids, blood pressure, and uric acid within normal limits may promote reversion to normoglycaemia. Among transitions to CHD alone and stroke alone, transition from T2DM had the highest rate (12.21/1000 and 12.16/1000 person-years), followed by transition from prediabetes (6.81/1000 and 4.93/1000 person-years), and normoglycaemia (3.28/1000 and 2.39/1000 person-years). Age and hypertension were associated with an accelerated rate for most transitions. Overweight/obesity, smoking, dyslipidemia, and hyperuricemia played crucial but different roles in transitions. Prediabetes was the optimal intervention stage in the disease trajectory. The derived transition rates, sojourn time, and influence factors could provide scientific support for the primary prevention of both T2DM and CVD.