Zandbergen Adrienne A M, Sijbrands Eric J, Lamberts Steven W, Bootsma Aart H
Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands.
Diabetes Care. 2006 Aug;29(8):1851-5. doi: 10.2337/dc06-0287.
The excess risk of macrovascular disease and death associated with diabetes seems higher in women than in men. The pathogenesis for this risk difference has not been fully elucidated. We investigated whether female sex was associated with macrovascular disease and death, independently of known risk factors related to type 2 diabetes, nephropathy, or retinopathy in normotensive patients with type 2 diabetes and microalbuminuria.
We conducted a prospective, prolonged follow-up study of a subgroup of 67 diabetic patients (46 men and 21 women) without established cardiovascular disease who participated in a larger clinical trial. Data were collected on current and past health, medication use, blood pressure, renal function, and HbA(1c) during the follow-up period of 4.7 +/- 0.8 (means +/- SE) years. The end point was a composite of death, cardiovascular disease, cerebrovascular events, and peripheral artery disease.
Of the women, eight (38.1%) met the end point compared with six (13.4%) of the men (P = 0.02 for difference in event-free survival). The hazard ratio of women relative to men was 3.19 (95% CI 1.11-9.21), which further increased after adjusting for age, systolic blood pressure, BMI, smoking, total-to-HDL cholesterol ratio, urinary albumin excretion, and retinopathy.
In our study population of normotensive patients with type 2 diabetes and microalbuminuria, female sex was associated with increased risk of fatal and nonfatal cardiovascular disease, independent of the classical cardiovascular risk factors, the severity of nephropathy or presence of retinopathy, or health care utilization.
与糖尿病相关的大血管疾病和死亡的额外风险在女性中似乎高于男性。这种风险差异的发病机制尚未完全阐明。我们调查了在患有2型糖尿病和微量白蛋白尿的血压正常患者中，女性性别是否与大血管疾病和死亡相关，而与2型糖尿病、肾病或视网膜病变的已知风险因素无关。
我们对67名无已确诊心血管疾病的糖尿病患者（46名男性和21名女性）亚组进行了一项前瞻性、长期随访研究，这些患者参与了一项更大规模的临床试验。在4.7±0.8（均值±标准误）年的随访期内，收集了有关当前和过去健康状况、药物使用、血压、肾功能和糖化血红蛋白（HbA1c）的数据。终点是死亡、心血管疾病、脑血管事件和外周动脉疾病的综合指标。
女性中有8名（38.1%）达到终点，而男性中有6名（13.4%）（无事件生存差异P = 0.02）。女性相对于男性的风险比为3.19（95%置信区间1.11 - 9.21），在调整年龄、收缩压、体重指数、吸烟、总胆固醇与高密度脂蛋白胆固醇比值、尿白蛋白排泄和视网膜病变后，该比值进一步升高。
在我们的2型糖尿病和微量白蛋白尿血压正常患者研究人群中，女性性别与致命和非致命心血管疾病风险增加相关，与经典心血管风险因素、肾病严重程度或视网膜病变的存在或医疗保健利用无关。
