血浆同型半胱氨酸水平升高是2型糖尿病患者冠心病事件的独立预测指标。

Elevated plasma homocysteine level is an independent predictor of coronary heart disease events in patients with type 2 diabetes mellitus.

作者信息

Soinio Minna, Marniemi Jukka, Laakso Markku, Lehto Seppo, Rönnemaa Tapani

机构信息

University of Turku, Turku, Finland.

出版信息

Ann Intern Med. 2004 Jan 20;140(2):94-100. doi: 10.7326/0003-4819-140-2-200401200-00009.

DOI:10.7326/0003-4819-140-2-200401200-00009

PMID:14734331

Abstract

BACKGROUND

High plasma homocysteine level has been associated with increased risk for coronary heart disease (CHD) events in nondiabetic individuals, especially in those with previously diagnosed CHD. In persons with type 2 diabetes mellitus, the association between homocysteine level and cardiovascular disease may be stronger than that in nondiabetic individuals, but no large prospective studies have examined the relationship between homocysteine level and CHD mortality in persons with type 2 diabetes.

OBJECTIVE

To investigate whether moderately elevated plasma homocysteine levels are independently related to increased incidence of fatal and nonfatal CHD events in persons with type 2 diabetes.

DESIGN

Prospective study.

SETTING

Finnish sample of patients with type 2 diabetes.

PATIENTS

462 men and 368 women who were 45 to 64 years of age at baseline.

MEASUREMENTS

Coronary heart disease mortality and incidence of nonfatal myocardial infarction during the 7-year follow-up.

RESULTS

Participants with plasma homocysteine levels of 15 micromol/L or more at baseline had a higher risk for CHD death than those with plasma homocysteine levels less than 15 micromol/L (26.1% and 13.5%, respectively; P = 0.005). The risks for all CHD events were 36.2% and 22.6%, respectively (P = 0.011). In Cox regression analyses, elevated plasma homocysteine level was significantly associated with CHD mortality (P < 0.001) and all CHD events (P = 0.002) even after adjustment for confounding variables, including creatinine clearance. In participants without myocardial infarction at baseline, moderate hyperhomocysteinemia was also associated with CHD mortality and all CHD events in univariate (P < 0.001 and P = 0.006, respectively) and multivariate Cox regression analyses (P < 0.001 and P = 0.004, respectively).

CONCLUSIONS

In this large cohort of patients with type 2 diabetes, plasma homocysteine level was a strong and independent risk factor for CHD events.

摘要

背景

高血浆同型半胱氨酸水平与非糖尿病个体冠心病（CHD）事件风险增加相关，尤其是在那些先前已诊断为冠心病的个体中。在2型糖尿病患者中，同型半胱氨酸水平与心血管疾病之间的关联可能比非糖尿病个体更强，但尚无大型前瞻性研究探讨2型糖尿病患者同型半胱氨酸水平与冠心病死亡率之间的关系。

目的

调查血浆同型半胱氨酸水平适度升高是否与2型糖尿病患者致命和非致命性冠心病事件发生率增加独立相关。

设计

前瞻性研究。

地点

芬兰2型糖尿病患者样本。

患者

462名男性和368名女性，基线时年龄为45至64岁。

测量

7年随访期间的冠心病死亡率和非致命性心肌梗死发生率。

结果

基线时血浆同型半胱氨酸水平为15微摩尔/升或更高的参与者比血浆同型半胱氨酸水平低于15微摩尔/升的参与者有更高的冠心病死亡风险（分别为26.1%和13.5%；P = 0.005）。所有冠心病事件的风险分别为36.2%和22.6%（P = 0.011）。在Cox回归分析中，即使在调整了包括肌酐清除率在内的混杂变量后，血浆同型半胱氨酸水平升高仍与冠心病死亡率（P < 0.001）和所有冠心病事件（P = 0.002）显著相关。在基线时无心肌梗死的参与者中，中度高同型半胱氨酸血症在单变量（分别为P < 0.001和P = 0.006）和多变量Cox回归分析（分别为P < 0.001和P = 0.004）中也与冠心病死亡率和所有冠心病事件相关。