Rossi Rosario, Cioni Elena, Nuzzo Annachiara, Origliani Giorgia, Modena Maria Grazia
Institute of Cardiology, Policlinico Hospital University of Modena and Reggio Emilia Via del Pozzo, 71-41100 Modena, Italy.
Diabetes Care. 2005 Mar;28(3):702-7. doi: 10.2337/diacare.28.3.702.
Both postmenopausal state and diabetes are associated with endothelial dysfunction and are well-known risk factors for atherosclerosis. However, the relationship of endothelium-dependent vasodilation and diabetes has never been prospectively evaluated. This study provided the opportunity to assess the association between endothelial vasodilation function and the incidence of diabetes in a cohort of apparently healthy postmenopausal women.
We conducted a prospective cohort study that began in 1997 with 840 apparently healthy, nonobese, postmenopausal women, aged 53 +/- 6 years, initially with normal glucose tolerance at the oral glucose tolerance test. All participants were followed up for a mean period of 3.9 +/- 0.7 years (range 0.5-6.9). Endothelial function was measured as flow-mediated dilation (FMD) of the brachial artery, using high-resolution ultrasound.
There were no significant differences in demographic, blood pressure, and biochemical profiles among each tertile group at baseline or at follow-up review. During follow-up, 102 women developed type 2 diabetes. The adjusted relative risk (RR) for women with FMD </=4.3 (lowest tertile) was 5.87 (95% CI 4.34-8.10) versus women with FMD >/=5.6 (highest tertile reference). Each 1-unit decrease of FMD was associated with a significant 32% (22-48%) increase in the multiple-adjusted RR of incident diabetes.
These prospective data indicate a significant increase in the RR of diabetes with each unit decrease of FMD. This could suggest that an impaired endothelial function may play a fundamental role in diabetogenesis in postmenopausal women.
绝经状态和糖尿病均与内皮功能障碍相关，且均为动脉粥样硬化的知名危险因素。然而，内皮依赖性血管舒张与糖尿病之间的关系从未得到前瞻性评估。本研究提供了一个机会，以评估一组看似健康的绝经后女性中内皮血管舒张功能与糖尿病发病率之间的关联。
我们进行了一项前瞻性队列研究，该研究始于1997年，共有840名看似健康、非肥胖的绝经后女性，年龄为53±6岁，口服葡萄糖耐量试验初始时糖耐量正常。所有参与者平均随访3.9±0.7年（范围0.5 - 6.9年）。使用高分辨率超声测量肱动脉的血流介导舒张（FMD）来评估内皮功能。
在基线或随访复查时，各三分位数组之间的人口统计学、血压和生化指标无显著差异。随访期间，102名女性患2型糖尿病。FMD≤4.3（最低三分位数）的女性与FMD≥5.6（最高三分位数参考）的女性相比，调整后的相对风险（RR）为5.87（95%CI 4.34 - 8.10）。FMD每降低1个单位，新发糖尿病的多因素调整RR显著增加32%（22 - 48%）。
这些前瞻性数据表明，FMD每降低一个单位，糖尿病的RR显著增加。这可能表明内皮功能受损可能在绝经后女性糖尿病发病中起重要作用。
