糖尿病和非糖尿病成人中预测心血管疾病事件的血脂指标：基于人群队列研究的 8.6 年随访结果。
Lipid measures for prediction of incident cardiovascular disease in diabetic and non-diabetic adults: results of the 8.6 years follow-up of a population based cohort study.
机构信息
Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Yaman street, Velenjak, Tehran, Iran.
出版信息
Lipids Health Dis. 2010 Jan 23;9:6. doi: 10.1186/1476-511X-9-6.
BACKGROUND
Diabetes is a strong risk factor for cardiovascular disease (CVD).The relative role of various lipid measures in determining CVD risk in diabetic patients is still a subject of debate. We aimed to compare performance of different lipid measures as predictors of CVD using discrimination and fitting characteristics in individuals with and without diabetes mellitus from a Middle East Caucasian population.
METHODS
The study population consisted of 1021 diabetic (men = 413, women = 608) and 5310 non-diabetic (men = 2317, women = 2993) subjects, aged > or = 30 years, free of CVD at baseline. The adjusted hazard ratios (HRs) for CVD were calculated for a 1 standard deviation (SD) change in total cholesterol (TC), log-transformed triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), non-HDL-C, TC/HDL-C and log-transformed TG/HDL-C using Cox proportional regression analysis. Incident CVD was ascertained over a median of 8.6 years of follow-up.
RESULTS
A total of 189 (men = 91, women = 98) and 263(men = 169, women = 94) CVD events occurred, in diabetic and non-diabetic population, respectively. The risk factor adjusted HRs to predict CVD, except for HDL-C, TG and TG/HDL-C, were significant for all lipid measures in diabetic males and were 1.39, 1.45, 1.36 and 1.16 for TC, LDL-C, non- HDL-C and TC/HDL-C respectively. In diabetic women, using multivariate analysis, only TC/HDL-C had significant risk [adjusted HR1.31(1.10-1.57)].Among non-diabetic men, all lipid measures, except for TG, were independent predictors for CVD however; a 1 SD increase in HDL-C significantly decreased the risk of CVD [adjusted HR 0.83(0.70-0.97)].In non-diabetic women, TC, LDL-C, non-HDL-C and TG were independent predictors.There was no difference in the discriminatory power of different lipid measures to predict incident CVD in the risk factor adjusted models, in either sex of diabetic and non-diabetic population.
CONCLUSION
Our data according to important test performance characteristics provided evidence based support for WHO recommendation that along with other CVD risk factors serum TC vs. LDL-C, non-HDL-C and TC/HDL-C is a reasonable lipid measure to predict incident CVD among diabetic men. Importantly, HDL-C did not have a protective effect for incident CVD among diabetic population; given that the HDL-C had a protective effect only among non- diabetic men.
背景
糖尿病是心血管疾病（CVD）的一个强有力的危险因素。各种血脂指标在确定糖尿病患者的 CVD 风险方面的相对作用仍然存在争议。我们旨在比较不同血脂指标在中东高加索人群中有无糖尿病患者中的预测 CVD 的能力，包括区分和拟合特征。
方法
研究人群包括 1021 例糖尿病（男性 413 例，女性 608 例）和 5310 例非糖尿病（男性 2317 例，女性 2993 例）患者，年龄≥30 岁，基线时无 CVD。使用 Cox 比例回归分析计算总胆固醇（TC）、对数转换甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、非高密度脂蛋白胆固醇（非 HDL-C）、TC/HDL-C 和对数转换 TG/HDL-C 每标准差（SD）变化的 CVD 调整后危险比（HR）。在中位 8.6 年的随访期间确定了 CVD 事件的发生。
结果
在糖尿病和非糖尿病人群中分别发生了 189 例（男性 91 例，女性 98 例）和 263 例（男性 169 例，女性 94 例）CVD 事件。除 HDL-C、TG 和 TG/HDL-C 外，所有血脂指标在糖尿病男性中预测 CVD 的风险因素调整 HR 均有显著意义，分别为 TC、LDL-C、非 HDL-C 和 TC/HDL-C 为 1.39、1.45、1.36 和 1.16。在糖尿病女性中，使用多变量分析，只有 TC/HDL-C 有显著风险[调整 HR1.31（1.10-1.57）]。在非糖尿病男性中，除 TG 外，所有血脂指标均为 CVD 的独立预测因素；然而，HDL-C 增加 1 SD 可显著降低 CVD 的风险[调整 HR 0.83（0.70-0.97）]。在非糖尿病女性中，TC、LDL-C、非 HDL-C 和 TG 是独立的预测因素。在糖尿病和非糖尿病人群的风险因素调整模型中，不同血脂指标预测 CVD 事件的区分能力没有差异。
结论
根据重要的测试性能特征，我们的数据为世界卫生组织的建议提供了循证支持，即除其他 CVD 危险因素外，血清 TC 与 LDL-C、非 HDL-C 和 TC/HDL-C 一起是预测糖尿病男性 CVD 事件的合理血脂指标。重要的是，HDL-C 对糖尿病患者的 CVD 事件没有保护作用；鉴于 HDL-C 仅对非糖尿病男性有保护作用。
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