We examined diabetes as a cardiovascular disease (CVD) risk equivalent based on diabetes severity and other CVD risk factors.

We pooled four U.S. cohorts (Atherosclerosis Risk in Communities [ARIC], Jackson Heart Study [JHS], Multi-Ethnic Study of Atherosclerosis [MESA], and Framingham Heart Study Offspring Cohort [FHS-Offspring]) and classified subjects into groups by baseline diabetes/CVD status (positive or negative). CVD risks of the diabetes mellitus (DM)+/CVD– group versus DM–/CVD+ group were examined by diabetes severity and in subgroups of other CVD risk factors. We developed an algorithm to identify subjects with CVD risk equivalent diabetes by comparing the relative CVD risk of being DM+/CVD– versus DM–/CVD+.

The pooled cohort included 27,730 subjects (mean age 58.5 years, 44.6% male). CVD rates per 1,000 person-years were 16.5, 33.4, 43.2, and 71.4 among those DM–/CVD–, DM+/CVD–, DM–/CVD+, and DM+/CVD+, respectively. Compared with those DM–/CVD+, CVD risks were similar or higher for those with HbA_1c ≥ 7%, diabetes duration ≥10 years, or diabetes medication use, while those with less severe diabetes had lower risks. Hazard ratios (95% CI) for DM+/CVD– vs. DM–/CVD+ were 0.96 (95% CI 0.86–1.07), 0.97 (0.88–1.07), 0.96 (0.82–1.13), 1.18 (0.98–1.41), 0.93 (0.85–1.02), and 1.00 (0.89–1.13) among women and those of White race, age <55 years, and with triglycerides ≥2.26 mmol/L, hs-CRP ≥2 mg/L, and estimated glomerular filtration rate <60 mL/min/1.73 m², respectively. In the DM+/CVD– group, 19.1% had CVD risk equivalent diabetes with a lower risk score but a higher observed CVD risk.

Diabetes is a CVD risk equivalent in one-fifth of CVD-free adults living with diabetes. High HbA_1c, long diabetes duration, and diabetes medication use were predictors of CVD risk equivalence. Diabetes is a CVD risk equivalent for women, white people, and those of younger age or with higher triglycerides or hs-CRP or reduced kidney function.

我们根据糖尿病严重程度和其他 CVD 危险因素，将糖尿病视为心血管疾病 (CVD) 风险当量。

我们汇集了四个美国队列（社区动脉粥样硬化风险 [ARIC]、杰克逊心脏研究 [JHS]、动脉粥样硬化多种族研究 [MESA] 和弗雷明汉心脏研究后代队列 [FHS-Offspring]），并根据基线将受试者分组糖尿病/CVD 状态（阳性或阴性）。通过糖尿病严重程度和其他 CVD 危险因素亚组检查糖尿病 (DM)+/CVD- 组与 DM-/CVD+ 组的 CVD 风险。我们开发了一种算法，通过比较 DM+/CVD- 与 DM-/CVD+ 的相对 CVD 风险来识别患有 CVD 风险等效糖尿病的受试者。

汇总队列包括 27,730 名受试者（平均年龄 58.5 岁，44.6% 为男性）。 DM-/CVD-、DM+/CVD-、DM-/CVD+ 和 DM+/CVD+ 人群中每 1000 人年的 CVD 率分别为 16.5、33.4、43.2 和 71.4。与 DM-/CVD+ 患者相比，HbA _1c ≥ 7%、糖尿病病程≥10 年或使用糖尿病药物的患者 CVD 风险相似或更高，而糖尿病不太严重的患者风险较低。 DM+/CVD– 与 DM–/CVD+ 的风险比 (95% CI) 分别为 0.96 (95% CI 0.86–1.07)、0.97 (0.88–1.07)、0.96 (0.82–1.13)、1.18 (0.98–1.41)、女性和年龄 <55 id=25>2 的白人中分别为 0.93 (0.85–1.02) 和 1.00 (0.89–1.13)。在 DM+/CVD- 组中，19.1% 患有 CVD 风险相当的糖尿病，其风险评分较低，但观察到的 CVD 风险较高。

对于五分之一的无心血管疾病的糖尿病成人来说，糖尿病与心血管疾病的风险相当。高 HbA _1c 、长糖尿病病程和糖尿病药物使用是 CVD 风险等效性的预测因子。对于女性、白人和较年轻的人、甘油三酯或 hs-CRP 较高或肾功能下降的人来说，糖尿病是一种 CVD 风险。