Scholarlink

Background <p>Optimization of HbA1c, blood pressure and cholesterol, referred to as the “ABCs”, is central to the management of diabetes. However, the age-specific associations of these factors with mortality in patients with diabetes remains unclear.</p> Methods <p>In this prospective cohort study, 43,732 Chinese adults aged ≥ 40 years with diabetes were included from the China Cardiometabolic Disease and Cancer Cohort (4C) Study. Participants were stratified by age (&lt; 55, 55-&lt;65, 65-&lt;75, ≥ 75 years). Cox proportional hazards regression and Fine-Gray competing risk models were employed to estimate the associations of HbA1c, systolic blood pressure (SBP), and low-density lipoprotein cholesterol (LDL-C) with all-cause, cardiovascular, and non-cardiovascular mortality across age groups. Relative importance and population attributable fractions (PAFs) were computed for each metabolic factor.</p> Results <p>During a median follow-up of 10.1 years, 3,975 deaths were documented. Age significantly modified the associations of HbA1c, SBP, and LDL-C with all mortality outcomes (all <i>P</i> for interaction &lt; 0.05). Among participants aged &lt; 75 years, HbA1c showed graded positive associations with all-cause, cardiovascular, and non-cardiovascular mortality. The SBP thresholds associated with increased mortality risk were 140 mmHg in those aged &lt; 65 years and 160 mmHg in those aged 65–&lt;75 years. Among those aged ≥ 75 years, however, the patterns of these associations differed markedly. Elevated mortality risk was observed only at HbA1c ≥ 9%, with a hazard ratio (HR) of 1.51 (95% confidence interval [CI]: 1.19–1.91) for all-cause mortality and a subdistribution hazard ratio (SHR) of 1.70 (95% CI: 1.23–2.36) for cardiovascular mortality, while SBP showed no significant association with any mortality outcome in this age group. Moreover, LDL-C emerged as a significant risk factor for cardiovascular mortality. Compared with participants with LDL-C &lt; 1.8 mmol/L, those with LDL-C of 1.8–&lt;2.6 mmol/L exhibited a significantly higher risk (SHR: 1.86; 95% CI: 1.11–3.11). Additionally, LDL-C had the largest PAF for cardiovascular mortality (9.6%) within this age group.</p> Conclusions <p>The impacts of ABC factors on mortality risk vary substantially by age among adults with diabetes. In patients aged ≥ 75 years, less stringent glycemic and blood pressure targets may be appropriate, whereas lipid management remains critically important for reducing cardiovascular mortality.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Age-stratified associations of glycemia, blood pressure, and cholesterol with mortality in diabetes: A prospective cohort study

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年5月30日

查看全文
  • Yuanyue Zhu,
  • Lin Lin,
  • Jie Zhang,
  • Xiaojing Jia,
  • Yuhong Chen,
  • Hong Qiao,
  • Mian Li,
  • Yu Xu,
  • Min Xu,
  • Tiange Wang,
  • Zhiyun Zhao,
  • Guijun Qin,
  • Yingfen Qin,
  • Xulei Tang,
  • Zhen Ye,
  • Lixin Shi,
  • Qing Su,
  • Xuefeng Yu,
  • Li Yan,
  • Qin Wan,
  • Gang Chen,
  • Zhengnan Gao,
  • Guixia Wang,
  • Feixia Shen,
  • Xuejiang Gu,
  • Zuojie Luo,
  • Li Chen,
  • Xinguo Hou,
  • Yanan Huo,
  • Qiang Li,
  • Yinfei Zhang,
  • Tianshu Zeng,
  • Chao Liu,
  • Youmin Wang,
  • Shengli Wu,
  • Tao Yang,
  • Huacong Deng,
  • Lulu Chen,
  • Jiajun Zhao,
  • Yiming Mu,
  • Guang Ning,
  • Jialin Liu,
  • Ruying Hu,
  • Yufang Bi,
  • Weiqing Wang,
  • Jieli Lu,
  • Weiguo Hu

摘要

Background

Optimization of HbA1c, blood pressure and cholesterol, referred to as the “ABCs”, is central to the management of diabetes. However, the age-specific associations of these factors with mortality in patients with diabetes remains unclear.

Methods

In this prospective cohort study, 43,732 Chinese adults aged ≥ 40 years with diabetes were included from the China Cardiometabolic Disease and Cancer Cohort (4C) Study. Participants were stratified by age (< 55, 55-<65, 65-<75, ≥ 75 years). Cox proportional hazards regression and Fine-Gray competing risk models were employed to estimate the associations of HbA1c, systolic blood pressure (SBP), and low-density lipoprotein cholesterol (LDL-C) with all-cause, cardiovascular, and non-cardiovascular mortality across age groups. Relative importance and population attributable fractions (PAFs) were computed for each metabolic factor.

Results

During a median follow-up of 10.1 years, 3,975 deaths were documented. Age significantly modified the associations of HbA1c, SBP, and LDL-C with all mortality outcomes (all P for interaction < 0.05). Among participants aged < 75 years, HbA1c showed graded positive associations with all-cause, cardiovascular, and non-cardiovascular mortality. The SBP thresholds associated with increased mortality risk were 140 mmHg in those aged < 65 years and 160 mmHg in those aged 65–<75 years. Among those aged ≥ 75 years, however, the patterns of these associations differed markedly. Elevated mortality risk was observed only at HbA1c ≥ 9%, with a hazard ratio (HR) of 1.51 (95% confidence interval [CI]: 1.19–1.91) for all-cause mortality and a subdistribution hazard ratio (SHR) of 1.70 (95% CI: 1.23–2.36) for cardiovascular mortality, while SBP showed no significant association with any mortality outcome in this age group. Moreover, LDL-C emerged as a significant risk factor for cardiovascular mortality. Compared with participants with LDL-C < 1.8 mmol/L, those with LDL-C of 1.8–<2.6 mmol/L exhibited a significantly higher risk (SHR: 1.86; 95% CI: 1.11–3.11). Additionally, LDL-C had the largest PAF for cardiovascular mortality (9.6%) within this age group.

Conclusions

The impacts of ABC factors on mortality risk vary substantially by age among adults with diabetes. In patients aged ≥ 75 years, less stringent glycemic and blood pressure targets may be appropriate, whereas lipid management remains critically important for reducing cardiovascular mortality.