Alexander C M, Landsman P B, Teutsch S M
Department of Outcomes Research and Management, Merck & Co, Inc, West Point, Pennsylvania, USA.
Am J Cardiol. 2000 Nov 1;86(9):897-902. doi: 10.1016/s0002-9149(00)01118-8.
Patients with diabetes mellitus (DM), both diagnosed (history of) and undiagnosed (by fasting glucose [FG] only), as well as impaired FG have an increased risk of coronary heart disease (CHD), compared with those with normal FG. Elevations in FG levels, even in normoglycemic subjects (<110 mg/dl), may be significantly related to CHD morbidity and mortality. Improving lipid profiles and blood pressure can decrease both CHD morbidity and mortality in these patients. We evaluated the relation of glucose status to lipid levels, other risk factors, and prevalence of CHD using the 1997 American Diabetes Association diagnostic criteria in a representative sample of United States adults studied in the Third National Health and Nutrition Examination Survey from 1988 to 1994. Impaired FG, diagnosed DM, and undiagnosed DM were more prevalent in older age groups; those > or =65 years had increased prevalence compared with those <50 years old (rate ratios for IFG, DM-FG, and history of DM were 3.5, 4.8, and 10.8, respectively). Glycosylated hemoglobin levels were increased by glucose status. The frequency of known CHD risk factors also increased with worsening glucose status. Age-adjusted CHD prevalence was increased with impaired FG (rate ratio 1.47), DM-FG (rate ratio 1.56), and history of DM (rate ratio 1.72), compared with normal FG. Adjusting for age and other CHD risk factors, hyperglycemia was no longer significantly associated with CHD prevalence. Lipid values, especially high-density lipoprotein cholesterol, hypertension, and other CHD risk factors were more strongly associated with CHD than glucose status. Thus, patients with impaired FG, DM-FG, and history of DM should be considered at higher risk for CHD morbidity and mortality. However, hyperglycemia, per se, does not explain the excess risk. In addition to glucose, lipid profiles and blood pressure should be periodically monitored and appropriate treatment provided to reduce morbidity and mortality from CHD.
与空腹血糖（FG）正常者相比，已确诊糖尿病（DM）（有病史）和未确诊糖尿病（仅通过空腹血糖检测）以及空腹血糖受损的患者患冠心病（CHD）的风险更高。即使在血糖正常的受试者（<110 mg/dl）中，FG水平升高也可能与冠心病的发病率和死亡率显著相关。改善血脂和血压可降低这些患者的冠心病发病率和死亡率。我们使用1997年美国糖尿病协会诊断标准，在1988年至1994年第三次全国健康和营养检查调查中研究的美国成年人代表性样本中，评估了血糖状态与血脂水平、其他危险因素以及冠心病患病率之间的关系。空腹血糖受损、已确诊糖尿病和未确诊糖尿病在老年人群中更为普遍；65岁及以上人群的患病率高于50岁以下人群（空腹血糖受损、糖尿病 - FG和糖尿病病史的发病率比分别为3.5、4.8和10.8）。糖化血红蛋白水平因血糖状态而升高。已知冠心病危险因素的频率也随着血糖状态的恶化而增加。与正常空腹血糖相比，年龄调整后的冠心病患病率在空腹血糖受损（发病率比1.47）、糖尿病 - FG（发病率比1.56）和糖尿病病史（发病率比1.72）时有所增加。在调整年龄和其他冠心病危险因素后，高血糖与冠心病患病率不再显著相关。血脂值，尤其是高密度脂蛋白胆固醇、高血压和其他冠心病危险因素与冠心病的关联比血糖状态更强。因此，空腹血糖受损、糖尿病 - FG和有糖尿病病史的患者应被视为患冠心病发病率和死亡率的高危人群。然而，高血糖本身并不能解释额外的风险。除了血糖外，还应定期监测血脂和血压，并提供适当治疗以降低冠心病的发病率和死亡率。
