Guzder R N, Gatling W, Mullee M A, Byrne C D
Poole Diabetes Centre, Poole Hospital NHS Trust, Poole, Dorset, UK.
Diabetologia. 2006 Jan;49(1):49-55. doi: 10.1007/s00125-005-0063-9. Epub 2005 Dec 10.
AIMS/HYPOTHESIS: We investigated the prognostic implication of metabolic syndrome according to modified National Cholesterol Education Program criteria and the implication of individual features of metabolic syndrome on cardiovascular disease (CVD) and CHD in a 5-year community-based study of people with newly diagnosed type 2 diabetes.
We entered 562 participants, aged 30-74 years, into a cross-sectional analysis and 428 participants (comprising those who were CVD-free at study entry) into a prospective analysis. In both analyses, the association of metabolic syndrome features with CVD/CHD was studied. Binary logistic regression, a Cox regression model and Fisher's exact test were used for statistical analyses.
At diagnosis of type 2 diabetes, metabolic syndrome was independently associated with CVD (odds ratio [OR] 2.54; p=0.006) and CHD (OR 4.06; p=0.002). In the 5-year follow-up, metabolic syndrome at baseline was an independent predictor of incident CVD (hazard ratio [HR] 2.05; p=0.019). An increase in the number of individual features of the metabolic syndrome present at the time of diagnosis of type 2 diabetes was associated with a linear increase in incident CVD risk (trend p=0.044) with an almost five-fold increase when all five features were present, compared with hyperglycaemia alone (HR 4.76; p=0.042). Increasing age (HR 1.07; p<0.001), female sex (HR 0.62; p=0.032), total cholesterol (HR 1.43; p=0.01) and lipid-lowering therapy (HR 0.32; p<0.001) were also independent predictors of risk.
CONCLUSIONS/INTERPRETATION: Metabolic syndrome at baseline is associated with an increased risk of incident CVD in the 5 years following diagnosis of type 2 diabetes. CVD-free survival rates declined incrementally as the presence of metabolic syndrome features increased. Thus, identifying the features of metabolic syndrome at diagnosis of type 2 diabetes is potentially a useful prognostic tool for identifying individuals at increased risk of CVD.
目的/假设：在一项针对新诊断出2型糖尿病患者的为期5年的社区研究中，我们根据修改后的美国国家胆固醇教育计划标准调查了代谢综合征的预后意义，以及代谢综合征个体特征对心血管疾病（CVD）和冠心病（CHD）的影响。
我们将562名年龄在30 - 74岁的参与者纳入横断面分析，并将428名参与者（包括研究开始时无CVD的参与者）纳入前瞻性分析。在这两种分析中，均研究了代谢综合征特征与CVD/CHD之间的关联。采用二元逻辑回归、Cox回归模型和Fisher精确检验进行统计分析。
在诊断2型糖尿病时，代谢综合征与CVD（比值比[OR] 2.54；p = 0.006）和CHD（OR 4.06；p = 0.002）独立相关。在5年的随访中，基线时的代谢综合征是新发CVD的独立预测因素（风险比[HR] 2.05；p = 0.019）。2型糖尿病诊断时存在的代谢综合征个体特征数量增加与新发CVD风险呈线性增加（趋势p = 0.044），当所有五个特征都存在时，与仅存在高血糖相比，风险增加近五倍（HR 4.76；p = 0.042）。年龄增加（HR 1.07；p < 0.001）、女性（HR 0.62；p = 0.032）、总胆固醇（HR 1.43；p = 0.01）和降脂治疗（HR 0.32；p < 0.001）也是风险的独立预测因素。
结论/解读：基线时的代谢综合征与2型糖尿病诊断后5年内新发CVD风险增加相关。随着代谢综合征特征的出现增加，无CVD生存率逐渐下降。因此，在诊断2型糖尿病时识别代谢综合征特征可能是识别CVD风险增加个体的有用预后工具。
