Maple-Brown L, Cunningham J, Celermajer D S, O'Dea K
Menzies School of Health Research, Darwin, Australia.
Clin Endocrinol (Oxf). 2007 Mar;66(3):419-25. doi: 10.1111/j.1365-2265.2007.02749.x.
Indigenous Australians have rates of cardiovascular (CVD) mortality some seven to 10-fold higher than non-Indigenous Australians aged 25-64 years. We aimed to evaluate the impact of type 2 diabetes and components of the metabolic syndrome on carotid intima-media thickness (CIMT) as a marker of cardiovascular risk in Indigenous Australians living in remote and urban environments and in Australians of European ancestry.
DESIGN, PATIENTS AND MEASUREMENTS: CIMT was measured by high-resolution B-mode ultrasound imaging of the common carotid artery in 119 remote Indigenous, 144 urban Indigenous and 122 urban European Australians with and without diabetes.
In nondiabetic participants, CIMT was lowest in Europeans (mean (SD) 0.64 mm (0.10)), higher in urban Indigenous Australians (0.67 mm (0.12)) and highest in remote Indigenous Australians (0.73 mm (0.15), P < 0.001). CIMT was higher with diabetes with the same pattern observed between populations: 0.73 mm, 0.79 mm and 0.82 mm, respectively (P < 0.001). Traditional risk factors (age, male gender, blood pressure and HbA1c) explained 35-45% of the variance of CIMT within each population group. However, differences in CIMT between population groups were maintained after adjustment for these cardiovascular risks plus cholesterol and smoking (P < 0.001). Factor analysis revealed that variables of the metabolic syndrome, together with smoking and elevated C-reactive protein (CRP) and urinary albumin-creatinine ratio (ACR), are likely to explain the higher CIMT in Indigenous Australians (and the urban-remote gradient). Unmeasured variables (genetic, psychosocial and socioeconomic) may also contribute to higher CIMT in these populations.
Glycaemic control and metabolic syndrome components contribute significantly to premature atherogenesis in Indigenous Australians and we recommend that therapy should be targeted accordingly.
澳大利亚原住民心血管疾病（CVD）死亡率比25 - 64岁的非澳大利亚原住民高约7至10倍。我们旨在评估2型糖尿病和代谢综合征各组分对颈动脉内膜中层厚度（CIMT）的影响，CIMT作为生活在偏远和城市环境中的澳大利亚原住民以及欧洲裔澳大利亚人心血管风险的一个标志物。
设计、患者与测量：对119名偏远地区原住民、144名城市原住民以及122名有或无糖尿病的城市欧洲裔澳大利亚人，通过对颈总动脉进行高分辨率B型超声成像测量CIMT。
在非糖尿病参与者中，CIMT在欧洲裔澳大利亚人中最低（均值（标准差）0.64毫米（0.10）），在城市原住民澳大利亚人中较高（0.67毫米（0.12）），在偏远地区原住民澳大利亚人中最高（0.73毫米（0.15），P < 0.001）。糖尿病患者的CIMT更高，各人群间呈现相同模式：分别为0.73毫米、0.79毫米和0.82毫米（P < 0.001）。传统危险因素（年龄、男性、血压和糖化血红蛋白）解释了各人群组内CIMT变异的35% - 45%。然而，在对这些心血管风险因素加上胆固醇和吸烟进行调整后，人群组间CIMT的差异仍然存在（P < 0.001）。因子分析显示，代谢综合征的变量，连同吸烟、C反应蛋白（CRP）升高以及尿白蛋白 - 肌酐比值（ACR），可能解释了澳大利亚原住民中较高的CIMT（以及城市 - 偏远地区梯度差异）。未测量的变量（遗传、心理社会和社会经济因素）也可能导致这些人群中CIMT升高。
血糖控制和代谢综合征各组分对澳大利亚原住民过早发生动脉粥样硬化有显著影响，我们建议相应地进行针对性治疗。
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