胰岛素依赖型糖尿病中的心血管疾病：与欧洲相比，美国发病率相似但风险因素不同。

Cardiovascular disease in insulin dependent diabetes mellitus: similar rates but different risk factors in the US compared with Europe.

作者信息

Orchard T J, Stevens L K, Forrest K Y, Fuller J H

机构信息

Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA, USA.

出版信息

Int J Epidemiol. 1998 Dec;27(6):976-83. doi: 10.1093/ije/27.6.976.

DOI:10.1093/ije/27.6.976

PMID:10024191

Abstract

BACKGROUND

Cardiovascular disease (CVD) in insulin dependent diabetes mellitus (IDDM) has been linked to renal disease. However, little is known concerning international variation in the correlations with hyperglycaemia and standard CVD risk factors.

METHODS

A cross-sectional comparison was made of prevalence rates and risk factor associations in two large studies of IDDM subjects: the Pittsburgh Epidemiology of Diabetes Complications Study (EDC) and the EURODIAB IDDM Complications Study from 31 centres in Europe. Subgroups of each were chosen to be comparable by age and duration of diabetes. The EDC population comprises 286 men (mean duration 20.1 years) and 281 women (mean duration 19.9 years); EURODIAB 608 men (mean duration 18.1 years) and 607 women (mean duration 18.9 years). The mean age of both populations was 28 years. Cardiovascular disease was defined by a past medical history of myocardial infarction, angina, and/or the Minnesota ECG codes (1.1-1.3, 4.1-4.3, 5.1-5.3, 7.1).

RESULTS

Overall prevalence of CVD was similar in the two populations (i.e. men 8.6% versus 8.0%, women 7.4% versus 8.5%, EURODIAB versus EDC respectively), although EDC women had a higher prevalence of angina (3.9% versus 0.5%, P < 0.001). Multivariate modelling suggests that glycaemic control (HbA1c) is not related to CVD in men. Age and high density lipoprotein cholesterol predict CVD in EURODIAB, while triglycerides and hypertension predict CVD in EDC. For women in both populations, age and hypertension (or renal disease) are independent predictors. HbA1c is also an independent predictor-inversely in EURODIAB women (P < 0.008) and positively in EDC women (P = 0.03). Renal disease was more strongly linked to CVD in EDC than in EURODIAB.

CONCLUSIONS

Despite a similar prevalence of CVD, risk factor associations appear to differ in the two study populations. Glycaemic control (HbA1c) does not show a consistent or strong relationship to CVD.

摘要

背景

胰岛素依赖型糖尿病（IDDM）中的心血管疾病（CVD）与肾脏疾病有关。然而，关于与高血糖和标准CVD危险因素相关性的国际差异知之甚少。

方法

对两项针对IDDM患者的大型研究中的患病率和危险因素关联进行了横断面比较：匹兹堡糖尿病并发症流行病学研究（EDC）和来自欧洲31个中心的欧洲糖尿病IDDM并发症研究。通过年龄和糖尿病病程选择每组的亚组使其具有可比性。EDC人群包括286名男性（平均病程20.1年）和281名女性（平均病程19.9年）；欧洲糖尿病研究（EURODIAB）有608名男性（平均病程18.1年）和607名女性（平均病程18.9年）。两组人群的平均年龄均为28岁。心血管疾病由心肌梗死、心绞痛的既往病史和/或明尼苏达心电图编码（1.1 - 1.3、4.1 - 4.3、5.1 - 5.3、7.1）定义。

结果

尽管EDC女性心绞痛患病率较高（3.9%对0.5%，P < 0.001），但两组人群中CVD的总体患病率相似（即男性分别为8.6%对8.0%，女性为7.4%对8.5%，欧洲糖尿病研究对EDC）。多变量模型表明，血糖控制（糖化血红蛋白）与男性的CVD无关。年龄和高密度脂蛋白胆固醇可预测欧洲糖尿病研究中的CVD，而甘油三酯和高血压可预测EDC中的CVD。对于两组人群中的女性，年龄和高血压（或肾脏疾病）是独立的预测因素。糖化血红蛋白也是一个独立的预测因素——在欧洲糖尿病研究女性中呈负相关（P < 0.008），在EDC女性中呈正相关（P = 0.03）。与欧洲糖尿病研究相比，肾脏疾病在EDC中与CVD的关联更强。