Wang Wei, Zhao Dong, Sun Jia-yi, Liu Jun, Qin Lan-ping, Wu Zhao-su
Department of Epidemiology, Beijing Anzhen Hospital Affiliated to the Capital University of Medical Science, Beijing 100029, China.
Zhonghua Nei Ke Za Zhi. 2007 Jan;46(1):20-4.
OBJECTIVE: To evaluate the effect of lowering the fasting plasma glucose (FPG) cutoff point for the criterion of impaired fasting glucose (IFG) in the 2003 ADA guideline on the prevalence of IFG and risk of ischemic cardiovascular diseases (ICVD) associated with IFG in Chinese population. METHOD: A prospective study was carried out in 11 provinces from 1992 to 2003. The baseline survey was conducted according to the WHO-MONICA protocol for risk factor surveys. These subjects have been followed-up for coronary heart disease (CHD) and stroke since the baseline survey. The association between baseline FPG and ICVD (CHD and ischemic stroke) events in 30 378 subjects aged 35 - 64 years in the 10-year follow-up period was analyzed. RESULTS: (1) Lowering the criterion for diagnosing IFG to 5.55 mmol/L increased the prevalence of IFG from 6.9% to 21.6% in Chinese population aged 35 - 64 years. (2) As compared with the group of FPG less than 5.55 mmol/L, the prevalence of other traditional CVD risk factors increased in the FPG level of 5.55 - 6.05, 6.11 - 6.94 and 6.99 mmol/L or above. (3) Univariate analysis method showed that the 10-year accumulated incidence and relative risk for ICVD increased with the elevated baseline level of FPG. (4) After adjusting for age and other ICVD risk factors (including hypertension, lipid disorder, smoking and obesity) FPG level of 5.55 - 6.05 mmol/L showed an independently predictive value for ICVD in men (RR = 1.302, 95% CI = 1.021 - 1.660), but not in women (RR = 1.255, 95% CI = 0.887 - 1.776). Hypertension, low HDL-C, smoking (men) and central obesity (women) were more strongly associated with ICVD than glucose status. CONCLUSIONS: The newly defined IFG criterion (FPG 5.55 - 6.94 mmol/L) increased the prevalence of IFG by more than 2 times in Chinese population aged 35 - 64 years. The 10-year accumulated incidence and relative risk for ICVD increased with the elevated baseline level of FPG. The predictive value of hyperglycemia for ICVD was weaker than that of other traditional risk factors. Comprehensive intervention for multiple risk factors clustering should be strengthened to reduce the overall risk of CVD.
目的：评估将2003年美国糖尿病协会（ADA）指南中空腹血糖受损（IFG）标准的空腹血糖（FPG）切点降低，对中国人群中IFG患病率及与IFG相关的缺血性心血管疾病（ICVD）风险的影响。 方法：1992年至2003年在11个省进行了一项前瞻性研究。基线调查按照世界卫生组织心血管疾病监测（WHO-MONICA）方案进行危险因素调查。自基线调查以来，对这些受试者进行冠心病（CHD）和中风的随访。分析了10年随访期内30378名35 - 64岁受试者的基线FPG与ICVD（CHD和缺血性中风）事件之间的关联。 结果：（1）将IFG诊断标准降低至5.55 mmol/L，使35 - 64岁中国人群中IFG患病率从6.9%增至21.6%。（2）与FPG低于5.55 mmol/L的组相比，FPG水平在5.55 - 6.05、6.11 - 6.94和6.99 mmol/L及以上时，其他传统心血管疾病危险因素的患病率增加。（3）单因素分析方法显示，ICVD的10年累积发病率和相对风险随基线FPG水平升高而增加。（4）在调整年龄和其他ICVD危险因素（包括高血压、血脂异常、吸烟和肥胖）后，FPG水平在5.55 - 6.05 mmol/L对男性ICVD具有独立预测价值（RR = 1.302，95%CI = 1.021 - 1.660），但对女性无此价值（RR = 1.255，95%CI = 0.887 - 1.776）。高血压、低高密度脂蛋白胆固醇、吸烟（男性）和中心性肥胖（女性）与ICVD的关联比血糖状态更强。 结论：新定义的IFG标准（FPG 5.55 - 6.94 mmol/L）使35 - 64岁中国人群中IFG患病率增加了2倍多。ICVD的10年累积发病率和相对风险随基线FPG水平升高而增加。高血糖对ICVD的预测价值弱于其他传统危险因素。应加强对多种危险因素聚集的综合干预，以降低心血管疾病的总体风险。
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