Although both a history of cerebrovascular disease (CVD) and glucose abnormality are risk factors for CVD, few large studies have examined their association with subsequent CVD in the same cohort. Thus, we compared the impact of prior CVD, glucose status, and their combinations on subsequent CVD using real-world data. This is a retrospective cohort study including 363,627 men aged 18–72 years followed for ≥ 3 years between 2008 and 2016. Participants were classified as normoglycemia, borderline glycemia, or diabetes defined by fasting plasma glucose, HbA1c, and antidiabetic drug prescription. Prior and subsequent CVD (i.e. ischemic stroke, transient ischemic attack, and non-traumatic intracerebral hemorrhage) were identified according to claims using ICD-10 codes, medical procedures, and questionnaires. Participants’ mean age was 46.1 ± 9.3, and median follow up was 5.2 (4.2, 6.7) years. Cox regression analysis showed that prior CVD + conferred excess risk for CVD regardless of glucose status (normoglycemia: hazard ratio (HR), 8.77; 95% CI 6.96–11.05; borderline glycemia: HR, 7.40, 95% CI 5.97–9.17; diabetes: HR, 5.73, 95% CI 4.52–7.25). Compared with normoglycemia, borderline glycemia did not influence risk of CVD, whereas diabetes affected subsequent CVD in those with CVD- (HR, 1.50, 95% CI 1.34–1.68). In CVD-/diabetes, age, current smoking, systolic blood pressure, high-density lipoprotein cholesterol, and HbA1c were associated with risk of CVD, but only systolic blood pressure was related to CVD risk in CVD + /diabetes. Prior CVD had a greater impact on the risk of CVD than glucose tolerance and glycemic control. In participants with diabetes and prior CVD, systolic blood pressure was a stronger risk factor than HbA1c. Individualized treatment strategies should consider glucose tolerance status and prior CVD.

中文翻译：

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既往脑血管疾病和血糖状态对日本脑血管疾病事件的影响

尽管脑血管疾病 (CVD) 病史和葡萄糖异常都是 CVD 的危险因素，但很少有大型研究在同一队列中检查它们与随后的 CVD 的关系。因此，我们使用真实世界的数据比较了先前 CVD、葡萄糖状态及其组合对后续 CVD 的影响。这是一项回顾性队列研究，包括 363,627 名 18-72 岁的男性，在 2008 年至 2016 年间随访 ≥ 3 年。参与者分为正常血糖、临界血糖或由空腹血糖、HbA1c 和抗糖尿病药物处方定义的糖尿病。根据使用 ICD-10 代码、医疗程序和问卷调查的声明，确定了之前和之后的 CVD（即缺血性中风、短暂性脑缺血发作和非创伤性脑出血）。参与者的平均年龄为 46.1 ± 9.3，中位随访时间为 5.2 (4.2, 6.7) 年。Cox 回归分析显示，无论血糖状态如何，既往 CVD + 都会导致 CVD 风险增加（血糖正常：风险比 (HR)，8.77；95% CI 6.96–11.05；临界血糖：HR，7.40，95% CI 5.97–9.17；糖尿病: HR, 5.73, 95% CI 4.52–7.25)。与正常血糖相比，临界血糖不影响 CVD 风险，而糖尿病影响 CVD- 患者随后的 CVD（HR，1.50，95% CI 1.34-1.68）。在 CVD-/糖尿病中，年龄、当前吸烟、收缩压、高密度脂蛋白胆固醇和 HbA1c 与 CVD 风险相关，但只有收缩压与 CVD + / 糖尿病患者的 CVD 风险相关。与葡萄糖耐量和血糖控制相比，既往 CVD 对 CVD 风险的影响更大。在患有糖尿病和既往 CVD 的参与者中，收缩压是比 HbA1c 更强的危险因素。个体化治疗策略应考虑葡萄糖耐量状态和既往 CVD。