Dallongeville J, Bringer J, Bruckert E, Charbonnel B, Dievart F, Komajda M, Pouchain D, Amouyel P
Service d'épidémiologie et santé publique, Inserm U744, institut Pasteur de Lille, 1, rue du Professeur-Calmette, 59019 Lille, France.
Diabetes Metab. 2008 Dec;34(6 Pt 1):606-11. doi: 10.1016/j.diabet.2008.07.001. Epub 2008 Nov 18.
Insufficient control of cardiovascular risk factors is observed in primary care. The goal of the present study was to evaluate the association of abdominal obesity with achievement of treatment targets for HbA(1c), LDL cholesterol, triglycerides, HDL cholesterol and blood pressure in primary care.
In this cross-sectional observational epidemiological study, primary-care practitioners completed a questionnaire covering demographic and socioeconomic data, medical history, drug treatment, and clinical and biological characteristics for 3351 patients (1630 men and 1721 women). Therapeutic targets were HbA(1c) <7%, LDL cholesterol <1.6g/L, triglycerides <1.5 g/L and SBP/DBP <140/90 mmHg. Multivariate analyses were performed to assess the relationship between waist circumference and a lack of cardiovascular risk-factor control.
The patients' mean ages were 58+/-14 years and 55+/-16 years for men and women, respectively. A large waist circumference was positively and significantly (P<0.0001 for all) associated with diabetes, hypercholesterolaemia, hypertriglyceridaemia, low HDL cholesterol and hypertension. The prevalence of patients not achieving therapeutic targets increased across waist-circumference quartiles. For treated patients, the odds ratios (95% CI) (adjusted for age, gender, education, smoking status and medical specialty) for not achieving treatment targets were 17.6 (2.2-142) for triglycerides, 2.8 (1.3-6.1) for HbA(1c) and 1.4 (0.9-2.0) for blood pressure on comparisons with extreme quartiles of waist-circumference distribution.
In primary care, a lack of control of triglycerides, HbA(1c) and, to a lesser extent, blood pressure increases with waist circumference independently of confounders. This suggests that abdominal obesity is associated of poor results in the treatment of diabetes and hypertriglyceridaemia.
在初级保健中观察到心血管危险因素控制不足。本研究的目的是评估腹部肥胖与初级保健中糖化血红蛋白（HbA₁c）、低密度脂蛋白胆固醇、甘油三酯、高密度脂蛋白胆固醇和血压治疗目标达成情况之间的关联。
在这项横断面观察性流行病学研究中，初级保健从业者完成了一份问卷，内容涵盖3351例患者（1630名男性和1721名女性）的人口统计学和社会经济数据、病史、药物治疗以及临床和生物学特征。治疗目标为HbA₁c<7%、低密度脂蛋白胆固醇<1.6g/L、甘油三酯<1.5g/L以及收缩压/舒张压<140/90mmHg。进行多变量分析以评估腰围与心血管危险因素控制不佳之间的关系。
男性和女性患者的平均年龄分别为58±14岁和55±16岁。大腰围与糖尿病、高胆固醇血症、高甘油三酯血症、低高密度脂蛋白胆固醇和高血压呈显著正相关（所有P<0.0001）。未达到治疗目标的患者患病率在腰围四分位数中呈上升趋势。对于接受治疗的患者，与腰围分布的极端四分位数相比，未达到治疗目标的比值比（95%可信区间）（根据年龄、性别、教育程度、吸烟状况和医学专业调整）在甘油三酯方面为17.6（2.2 - 142），在HbA₁c方面为2.8（1.3 - 6.1），在血压方面为1.4（0.9 - 2.0）。
在初级保健中，甘油三酯、HbA₁c以及在较小程度上血压控制不佳随腰围增加而增加，且独立于混杂因素。这表明腹部肥胖与糖尿病和高甘油三酯血症治疗效果不佳相关。
