| アブストラクト | To assess 20-year retrospective trajectories of cardio-metabolic factors preceding dementia diagnosis among people with type 2 diabetes (T2D). We identified 227,145 people with T2D aged > 42 years between 1999 and 2018. Annual mean levels of eight routinely measured cardio-metabolic factors were extracted from the Clinical Practice Research Datalink. Multivariable multilevel piecewise and non-piecewise growth curve models assessed retrospective trajectories of cardio-metabolic factors by dementia status from up to 19 years preceding dementia diagnosis (dementia) or last contact with healthcare (no dementia). 23,546 patients developed dementia; mean (SD) follow-up was 10.0 (5.8) years. In the dementia group, mean systolic blood pressure increased 16-19 years before dementia diagnosis compared with patients without dementia, but declined more steeply from 16 years before diagnosis, while diastolic blood pressure generally declined at similar rates. Mean body mass index followed a steeper non-linear decline from 11 years before diagnosis in the dementia group. Mean blood lipid levels (total cholesterol, LDL, HDL) and glycaemic measures (fasting plasma glucose and HbA1c) were generally higher in the dementia group compared with those without dementia and followed similar patterns of change. However, absolute group differences were small. Differences in levels of cardio-metabolic factors were observed up to two decades prior to dementia diagnosis. Our findings suggest that a long follow-up is crucial to minimise reverse causation arising from changes in cardio-metabolic factors during preclinical dementia. Future investigations which address associations between cardiometabolic factors and dementia should account for potential non-linear relationships and consider the timeframe when measurements are taken. |
|---|
| 投稿者 | Lai, Heidi T M; Chang, Kiara; Sharabiani, Mansour T A; Valabhji, Jonathan; Gregg, Edward W; Middleton, Lefkos; Majeed, Azeem; Pearson-Stuttard, Jonathan; Millett, Christopher; Bottle, Alex; Vamos, Eszter P |
|---|
| 組織名 | Public Health Policy Evaluation Unit, School of Public Health, Imperial College;London, St Dunstan's Road, London, W6 8RP, UK. h.lai@imperial.ac.uk.;Department of Primary Care and Public Health, School of Public Health, Imperial;College London, London, UK. h.lai@imperial.ac.uk.;London, St Dunstan's Road, London, W6 8RP, UK.;College London, London, UK.;NHS England, London, UK.;Department of Diabetes and Endocrinology, St Mary's Hospital, Imperial College;Healthcare NHS Trust, London, UK.;Division of Metabolism, Digestion and Reproduction, Imperial College London,;London, UK.;School of Population Health, RCSI University of Medicine and Health Sciences,;Dublin, Ireland.;Department of Epidemiology and Biostatistics, School of Public Health, Imperial;Ageing Epidemiology Research Unit, School of Public Health, Imperial College;London, London, UK.;Imperial College Healthcare NHS Trust, London, UK.;Health Analytics, Lane Clark & Peacock LLP, London, UK.;Northumbria Healthcare NHS Foundation Trust, North Shields, UK.;Public Health Research Centre, Comprehensive Health Research Center, NOVA;National School of Public Health, CHRC, NOVA University Lisbon, Lisbon, Portugal. |
|---|
