Harris Stewart B, Zinman Bernard, Hanley Anthony, Gittelsohn Joel, Hegele Robert, Connelly Phillip W, Shah Baiju, Hux Janet E
Department of Family Medicine, Department of Biostatistics and Epidemiology, The University of Western Ontario, London, Ont., Canada.
Diabetes Res Clin Pract. 2002 Feb;55(2):165-73. doi: 10.1016/s0168-8227(01)00316-3.
We measured cardiovascular disease (CVD) risk factors and their relationship to glucose intolerance in a Native Canadian population with very high rates of Type 2 diabetes mellitus. Five hundred and twenty five study-eligible Ojibwa-Cree individuals age 18 and over in the community of Sandy Lake, Canada who had participated in a population-based survey were studied. Diabetes status, plasma concentrations of total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C), calculated low density lipoprotein-cholesterol (LDL-C), waist/hip ratio (WHR), BMI, systolic and diastolic BP, and history of smoking were compared to a standard national population. Extremely high rates of obesity (BMI and WHR) were identified in the study population and were associated with increasing glucose intolerance for both males and females. Rates of smoking exceeded 70 and 80% in females and males, respectively. Interestingly, despite obesity individuals who had normal glucose tolerance had significantly lower rates of high risk TC, TG, LDL-C, and HDL-C levels compared to a national Canadian population survey. However, with worsening glucose intolerance, TC, TG, LDL-C and HDL-C dramatically deteriorated in comparison to nationally published levels. These changes in cardiovascular risk factors, as a consequence of diabetes, appear to result in increased clinical outcomes. Admission to hospital for Ischemic Heart Disease (IHD) for Sandy Lake residents increased from a rate of 34.8/10,000 to 109.1/10,000 in 15 years. Although this and similar populations have historically reported low rates of CVD, the impact of diabetes on lipid risk factor is having devastating consequences on cardiovascular outcomes. This trend is expected to continue unless the high rates of diabetes can be modified.
我们在2型糖尿病发病率极高的加拿大原住民人群中，测量了心血管疾病（CVD）风险因素及其与葡萄糖不耐受的关系。对加拿大桑迪湖社区525名年龄在18岁及以上、符合研究条件且参与了一项基于人群的调查的奥吉布瓦-克里族个体进行了研究。将糖尿病状态、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、计算得出的低密度脂蛋白胆固醇（LDL-C）、腰臀比（WHR）、体重指数（BMI）、收缩压和舒张压以及吸烟史与全国标准人群进行了比较。研究人群中肥胖率（BMI和WHR）极高，且与男性和女性葡萄糖不耐受的增加有关。女性和男性的吸烟率分别超过70%和80%。有趣的是，尽管存在肥胖情况，但葡萄糖耐量正常的个体与加拿大全国人群调查相比，高风险TC、TG、LDL-C和HDL-C水平的发生率显著较低。然而，随着葡萄糖不耐受情况的恶化，与全国公布的水平相比，TC、TG、LDL-C和HDL-C显著恶化。糖尿病导致的这些心血管风险因素变化似乎会导致临床结局增加。桑迪湖居民因缺血性心脏病（IHD）住院的比例在15年内从34.8/10000增加到109.1/10000。尽管这个以及类似人群历来报告的心血管疾病发生率较低，但糖尿病对脂质风险因素的影响正在对心血管结局产生毁灭性后果。除非能改变糖尿病的高发病率，否则这种趋势预计将持续下去。
