Department of Endocrinology, Affiliated Zhongda Hospital of Southeast University, Nanjing, Jiangsu 210009, China.
Chin Med J (Engl). 2009 Nov 5;122(21):2567-72.
Dyslipidaemia is a potential independent risk factor for cerebrovascular disease in patients with diabetes. The aim of this study was to investigate dyslipidaemia, treatment and control of dyslipidaemia among diabetic patients with ischemic stroke in a Chinese hospital.
A total of 1046 type 2 diabetic patients were assigned to diabetes with (n = 522) and diabetes without stroke groups. The two groups were matched by gender, age and diabetes duration. Lipid and lipoprotein profile were measured. Serum level and control of lipids were assessed and classified according to American Diabetes Association (ADA) guidelines and an intensified low density lipoprotein-cholesterol (LDL-C) target recommended in Chinese dyslipidaemia control criteria.
Diabetic patients suffering stroke displayed not only poorly-controlled lipid and lipoprotein profiles, including the significantly lower proportion of patients achieving intensified LDL-C target of < 2.07 mmol/L (80 mg/dl), and high density lipoprotein-cholesterol (HDL-C) target (14.4% vs 21.0%, P = 0.005; 45.8% vs 51.9%, P = 0.048 respectively), but also less adherence to therapy prescribed for dyslipidaemia (30.8% vs 41.0%, P = 0.001), when compared with diabetic patients without stroke. For the diabetic women with stroke, situation of dyslipidaemia was worse, with significantly lower serum level of HDL-C and apoA1, higher LDL-C level and higher ratio of apoB/apoA1 when compared with diabetic counterparts without stroke.
Many diabetic patients with ischemic stroke remain uncontrolled for dyslipidaemia. Intensified LDL-C and overall lipid lowering clinical goals are potential precautions taken against ischemic stroke among diabetic patients in China.
血脂异常是糖尿病患者发生脑血管疾病的潜在独立危险因素。本研究旨在探讨中国某医院缺血性脑卒中糖尿病患者的血脂异常、血脂治疗及控制情况。
共纳入 1046 例 2 型糖尿病患者，分为糖尿病合并脑梗死组（n=522）和糖尿病无脑梗死组。两组按性别、年龄和糖尿病病程匹配。检测血脂及脂蛋白谱。根据美国糖尿病协会（ADA）指南和中国血脂异常防治指南推荐的强化低密度脂蛋白胆固醇（LDL-C）目标，评估血清水平和血脂控制情况，并进行分类。
脑卒中糖尿病患者不仅血脂和脂蛋白谱控制不佳，包括达到强化 LDL-C 目标<2.07mmol/L（80mg/dl）的患者比例显著降低（分别为 14.4%比21.0%，P=0.005；45.8%比51.9%，P=0.048），而且血脂治疗的依从性也较差（分别为 30.8%比41.0%，P=0.001），与无脑梗死的糖尿病患者相比。对于脑卒中的女性糖尿病患者，血脂异常的情况更差，与无脑梗死的糖尿病患者相比，其血清 HDL-C 和载脂蛋白 A1 水平显著降低，LDL-C 水平升高，载脂蛋白 B/载脂蛋白 A1 比值升高。
许多缺血性脑卒中的糖尿病患者血脂控制不理想。强化 LDL-C 和整体降脂的临床目标可能是中国糖尿病患者预防缺血性脑卒中的潜在措施。
