Kuller L H, Velentgas P, Barzilay J, Beauchamp N J, O'Leary D H, Savage P J
Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA 15261, USA. kuller+@pitt.edu
Arterioscler Thromb Vasc Biol. 2000 Mar;20(3):823-9. doi: 10.1161/01.atv.20.3.823.
Previously diagnosed diabetes mellitus, newly diagnosed diabetes mellitus, and impaired glucose tolerance are important determinants of the risk of clinical cardiovascular disease (CVD). We have evaluated the relation of patients with subclinical CVD, diabetes, and impaired glucose tolerance and "normal" subjects and the risk of clinical CVD in the Cardiovascular Health Study. Diabetes (1343), impaired glucose tolerance (1433), and normal (2421) were defined by World Health Organization criteria at baseline in 1989 to 1990. The average follow-up was 6.4 years (mean age 73 years). Diabetics had a higher prevalence of clinical and subclinical CVD at baseline. Compared with diabetes in the absence of subclinical disease, the presence of subclinical CVD and diabetes was associated with significant increased adjusted relative risk of death (1.5, CI 0.93 to 2.41), relative risk of incident coronary heart disease (1.99, CI 1.25 to 3.19), and incident myocardial infarction (1.93, CI 0.96 to 3.91). The risk of clinical events was greater for participants with a history of diabetes compared with newly diagnosed diabetics at baseline. Compared with nondiabetic nonhypertensive subjects without subclinical disease, patients with a combination of diabetes, hypertension, and subclinical disease had a 12-fold increased risk of stroke. Fasting blood glucose levels were a weak predictor of incident coronary heart disease as were most other risk factors. Subclinical CVD was the primary determinant of clinical CVD among diabetics in the Cardiovascular Health Study.
先前诊断的糖尿病、新诊断的糖尿病和糖耐量受损是临床心血管疾病（CVD）风险的重要决定因素。我们在心血管健康研究中评估了亚临床CVD、糖尿病、糖耐量受损患者与“正常”受试者的关系以及临床CVD的风险。糖尿病（1343例）、糖耐量受损（1433例）和正常（2421例）是根据1989年至1990年基线时的世界卫生组织标准定义的。平均随访时间为6.4年（平均年龄73岁）。糖尿病患者在基线时临床和亚临床CVD的患病率较高。与无亚临床疾病的糖尿病相比，亚临床CVD和糖尿病的存在与死亡的调整后相对风险显著增加（1.5，可信区间0.93至2.41）、冠心病事件的相对风险（1.99，可信区间1.25至3.19）以及心肌梗死事件的相对风险（1.93，可信区间0.96至3.91）相关。与基线时新诊断的糖尿病患者相比，有糖尿病病史的参与者发生临床事件的风险更大。与无亚临床疾病的非糖尿病非高血压受试者相比，糖尿病、高血压和亚临床疾病并存的患者中风风险增加了12倍。空腹血糖水平与大多数其他风险因素一样，是冠心病事件的弱预测因子。在心血管健康研究中，亚临床CVD是糖尿病患者临床CVD的主要决定因素。
