Vischer U M, Safar M E, Safar H, Iaria P, Le Dudal K, Henry O, Herrmann F R, Ducimetière P, Blacher J
Department of Rehabilitation and Geriatrics, hôpital des Trois-Chêne, 3, chemin du Pont-Bochet, 1226 Thonex, Suisse.
Diabetes Metab. 2009 Apr;35(2):108-14. doi: 10.1016/j.diabet.2008.08.006. Epub 2009 Feb 23.
Diabetes or insulin resistance, overweight, arterial hypertension, and dyslipidaemia are recognized risk factors for cardiovascular (CV) disease. However, their predictive value and hierarchy in elderly subjects remain uncertain.
We investigated the impact of cardiometabolic risk factors on mortality in a prospective cohort study of 331 elderly high-risk subjects (mean age+/-SD: 85+/-7 years).
Two-year total mortality was predicted by age, diabetes, low BMI, low diastolic blood pressure (DBP), low total and HDL cholesterol, and previous CV events. The effect of diabetes was explained by previous CV events. In non-diabetic subjects, mortality was predicted by high insulin sensitivity, determined by HOMA-IR and QUICKI indices. In multivariate analyses, the strongest mortality predictors were low BMI, low HDL cholesterol and previous myocardial infarction. Albumin, a marker of malnutrition, was associated with blood pressure, total and HDL cholesterol, and HOMA-IR. The inflammation marker CRP was associated with low total and HDL cholesterol, and high HOMA-IR.
In very old patients, low BMI, low DBP, low total and HDL cholesterol, and high insulin sensitivity predict total mortality, indicating a "reverse metabolic syndrome" that is probably attributable to malnutrition and/or chronic disorders. These inverse associations limit the relevance of conventional risk factors. Previous CV events and HDL cholesterol remain strong predictors of mortality. Future studies should determine if and when the prevention and treatment of malnutrition in the elderly should be incorporated into conventional CV prevention.
糖尿病或胰岛素抵抗、超重、动脉高血压和血脂异常是公认的心血管（CV）疾病风险因素。然而，它们在老年受试者中的预测价值和层级关系仍不确定。
我们在一项对331名老年高危受试者（平均年龄±标准差：85±7岁）的前瞻性队列研究中，调查了心脏代谢风险因素对死亡率的影响。
年龄、糖尿病、低体重指数、低舒张压（DBP）、低总胆固醇和高密度脂蛋白胆固醇以及既往CV事件可预测两年总死亡率。糖尿病的影响可由既往CV事件解释。在非糖尿病受试者中，死亡率可通过由HOMA-IR和QUICKI指数确定的高胰岛素敏感性来预测。在多变量分析中，最强的死亡率预测因素是低体重指数、低高密度脂蛋白胆固醇和既往心肌梗死。白蛋白作为营养不良的标志物，与血压、总胆固醇和高密度脂蛋白胆固醇以及HOMA-IR相关。炎症标志物CRP与低总胆固醇和高密度脂蛋白胆固醇以及高HOMA-IR相关。
在非常老年的患者中，低体重指数、低DBP、低总胆固醇和高密度脂蛋白胆固醇以及高胰岛素敏感性可预测总死亡率，表明存在一种“反向代谢综合征”，这可能归因于营养不良和/或慢性疾病。这些反向关联限制了传统风险因素的相关性。既往CV事件和高密度脂蛋白胆固醇仍然是死亡率的强预测因素。未来的研究应确定是否以及何时将老年人营养不良的预防和治疗纳入传统的CV预防中。
