Rubins Hanna Bloomfield, Robins Sander J, Collins Dorothea, Nelson David B, Elam Marshall B, Schaefer Ernst J, Faas Fred H, Anderson James W
Section of General Internal Medicine (111O), Veterans Affairs Medical Center, 1 Veterans Dr, Minneapolis, MN 55417.
Arch Intern Med. 2002;162(22):2597-604. doi: 10.1001/archinte.162.22.2597.
Diabetes mellitus, impaired fasting glucose level, or insulin resistance are associated with increased risk of cardiovascular disease.
To determine the efficacy of gemfibrozil in subjects with varying levels of glucose tolerance or hyperinsulinemia and to examine the association between diabetes status and glucose and insulin levels and risk of cardiovascular outcomes.
Subgroup analyses from the Department of Veterans Affairs High-Density Lipoprotein Intervention Trial, a randomized controlled trial that enrolled 2531 men with coronary heart disease (CHD), a high-density lipoprotein cholesterol level of 40 mg/dL or less (</=1.04 mmol/L), and a low-density lipoprotein cholesterol level of 140 mg/dL or less (</=3.63 mmol/L). Subjects received either gemfibrozil (1200 mg/d) or matching placebo and were followed up for an average of 5.1 years. In this article, we report the composite end point (CHD death, stroke, or myocardial infarction).
Compared with those with a normal fasting glucose level, risk was increased in subjects with known diabetes (hazard ratio [HR], 1.87; 95% confidence interval [CI], 1.44-2.43; P =.001) and those with newly diagnosed diabetes (HR, 1.72; 95% CI, 1.10-2.68; P =.02). In persons without diabetes, a fasting plasma insulin level of 39 micro U/mL or greater (>/=271 pmol/L) was associated with a 31% increased risk of events (P =.03). Gemfibrozil was effective in persons with diabetes (risk reduction for composite end point, 32%; P =.004). The reduction in CHD death was 41% (HR, 0.59; 95% CI, 0.39-0.91; P =.02). Among individuals without diabetes, gemfibrozil was most efficacious for those in the highest fasting plasma insulin level quartile (risk reduction, 35%; P =.04).
In men with CHD and a low high-density lipoprotein cholesterol level, gemfibrozil use was associated with a reduction in major cardiovascular events in persons with diabetes and in nondiabetic subjects with a high fasting plasma insulin level.
糖尿病、空腹血糖受损或胰岛素抵抗与心血管疾病风险增加相关。
确定吉非贝齐在不同糖耐量水平或高胰岛素血症受试者中的疗效，并研究糖尿病状态与血糖、胰岛素水平以及心血管结局风险之间的关联。
来自退伍军人事务部高密度脂蛋白干预试验的亚组分析，这是一项随机对照试验，纳入了2531名患有冠心病（CHD）、高密度脂蛋白胆固醇水平为40mg/dL或更低（≤1.04mmol/L）且低密度脂蛋白胆固醇水平为140mg/dL或更低（≤3.63mmol/L）的男性。受试者接受吉非贝齐（1200mg/d）或匹配的安慰剂治疗，并平均随访5.1年。在本文中，我们报告复合终点（CHD死亡、中风或心肌梗死）。
与空腹血糖水平正常者相比，已知糖尿病患者（风险比[HR]，1.87；95%置信区间[CI]，1.44 - 2.43；P = 0.001）和新诊断糖尿病患者（HR，1.72；95%CI，1.10 - 2.68；P = 0.02）的风险增加。在无糖尿病者中，空腹血浆胰岛素水平为39微单位/毫升或更高（≥271皮摩尔/升）与事件风险增加31%相关（P = 0.03）。吉非贝齐对糖尿病患者有效（复合终点风险降低32%；P = 0.004）。CHD死亡降低41%（HR，0.59；95%CI，0.39 - 0.91；P = 0.02）。在无糖尿病个体中，吉非贝齐对空腹血浆胰岛素水平处于最高四分位数者最有效（风险降低35%；P = 0.04）。
在患有CHD且高密度脂蛋白胆固醇水平低的男性中，使用吉非贝齐与糖尿病患者以及空腹血浆胰岛素水平高的非糖尿病受试者主要心血管事件减少相关。
