Individual and Combined Cardiometabolic Morbidities and the Subsequent Risk of Cardiovascular Events in Chinese Adults: The China Cardiometabolic Disease and Cancer Cohort Study
Authors: Wang Jiao , Wang Zhimin , Guo Feng , Zhang Yinghui , Ji Hongfei , Chen Gang , Wan Qin , Yan Li , Wang Guixia , Qin Yingfen , Luo Zuojie , Tang Xulei , Huo Yanan , Hu Ruying , Ye Zhen , Shi Lixin , Gao Zhengnan , Su Qing , Mu Yiming , Zhao Jiajun , Chen Lulu , Zeng Tianshu , Yu Xuefeng , Li Qiang , Shen Feixia , Chen Li , Zhang Yinfei , Wang Youmin , Deng Huacong , Liu Chao , Wu Shengli , Yang Tao , Li Mian , Xu Yu , Xu Min , Zhao Zhiyun , Wang Tiange , Lu Jieli , Bi Yufang , Wang Weiqing , Ning Guang , Zhao Yanyan , Qin Guijun 
Published: December 2020

Abstract
Background The data regarding the association between main cardiometabolic morbidities such as diabetes, hypertension, and dyslipidemia and the subsequent risk of CVD events in Chinese adults are still limited. Therefore, we investigated the associations between individual and combined cardiometabolic morbidities and incident cardiovascular events in Chinese adults.Methods The China Cardiometabolic Disease and Cancer Cohort Study was a prospective, nationwide, and population-based cohort study of 20 Chinese communities from various geographic regions. A comprehensive set of questionnaires, clinical measurements, oral glucose tolerance tests (OGTTs), and laboratory examinations were carried out at baseline (2011-2012) and follow-up visits (2014-2016). 133572 participants aged ≥ 40 years who were free from cardiovascular disease (CVD) at baseline were included in the study.Results Compared with participants without diabetes, hypertension and dyslipidemia, participants with only diabetes (hazard ratio [HR], 1.58; 95% confidence interval [CI], 1.32-1.90) or only hypertension (2.04; 1.82-2.28) exhibited significantly higher risk for CVD events, while participants with only dyslipidemia (0.97; 0.84-1.12) exhibited no significantly higher risk for CVD events. When analyzed collectively, participants with diabetes plus hypertension (HR, 2.67; 95%CI, 2.33-3.06), diabetes plus dyslipidemia (1.57; 1.32-1.87), and hypertension plus dyslipidemia (2.12; 1.88-2.39) exhibited significantly higher risk for CVD events. Moreover, participants with the combination of diabetes, hypertension and dyslipidemia exhibited the highest risk for CVD events (HR, 3.06; 95%CI, 2.71-3.46). Multivariable-adjusted HRs (95% CIs) for CVD associated with diabetes based on fasting glucose ≥7.0 mmol/L, OGTT-2h glucose ≥11.1 mmol/L, and hemoglobin A1c ≥6.5% were 1.64 (1.51-1.78), 1.57 (1.45-1.69), and 1.54 (1.42-1.66), respectively; associated with hypertension based on systolic blood pressure ≥140 mmHg and diastolic blood pressure ≥90 mmHg were 1.89 (1.76-2.03) and 1.74 (1.60-1.88), respectively; associated with dyslipidemia based on total cholesterol ≥6.22 mmol/L, low-density lipoprotein cholesterol ≥4.14 mmol/L, high-density lipoprotein cholesterol <1.04 mmol/L, and triglycerides ≥2.26 mmol/L were 1.18 (1.08-1.30), 1.30 (1.17-1.44), 1.00 (0.92-1.09), and 1.10 (1.01-1.20), respectively. ConclusionsDiabetes, hypertension and dyslipidemia showed additive associations with the risk of CVD events in middle-aged and elderly Chinese adults.