School of Medicine and Pharmacology, Fremantle Hospital, University of Western Australia, Fremantle, Western Australia, Australia.
Eur J Endocrinol. 2010 Oct;163(4):559-64. doi: 10.1530/EJE-10-0474. Epub 2010 Aug 6.
To determine whether cardiac and all-cause mortality are lower in Southern European (SE) patients than in Anglo-Celt (AC) patients with type 2 diabetes in an urban Australian setting, and, if so, whether ethnicity-specific differences in apolipoprotein E (APOE) genotypes are contributory.
Longitudinal observational cohort study.
We analysed detailed data from 1057 patients from the community-based Fremantle Diabetes Study, 238 were of an SE migrant background and 819 of AC ethnicity. Cox proportional hazards modelling was used to identify independent predictors of cardiac and all-cause mortality.
During 9.8±3.5 years of follow-up, 411 (38.9%) participants died, 161 (39.2%) from cardiac causes. Significant positive baseline independent predictors of cardiac death were age, male gender, coronary heart disease, cerebrovascular disease, peripheral arterial disease, retinopathy and peripheral neuropathy (P≤0.004), while maternal history of diabetes was protective (P=0.014). After adjusting for these variables, APOE4 carriage was predictive (hazard ratio (95% confidence interval) 1.61 (1.01-2.58); P=0.048). SE ethnicity did not add significantly to the model either as a single variable or as an interaction term with APOE4 carriage (P≥0.86). Significant independent predictors of all-cause mortality were age, male gender, smoking, coronary heart disease, cerebrovascular disease, peripheral arterial disease, retinopathy, peripheral neuropathy and microalbuminuria (P≤0.047), while overweight/obesity, lipid-lowering therapy and recent exercise were protective (P≤0.008). APOE4 carriage, SE ethnicity and their interaction did not add to the model (P≥0.32).
SE ethnicity does not confer an independent survival advantage in community-based Australian type 2 diabetic patients, but APOE4 carriers are at higher risk of cardiac death.
在澳大利亚城市环境中，确定与盎格鲁-撒克逊（AC）患者相比，南欧（SE）患者的 2 型糖尿病患者的心脏和全因死亡率是否更低，如果是这样，载脂蛋白 E（APOE）基因型的种族特异性差异是否有贡献。
纵向观察队列研究。
我们分析了来自社区为基础的弗里曼特尔糖尿病研究的 1057 名患者的详细数据，其中 238 名患者具有 SE 移民背景，819 名患者具有 AC 种族背景。使用 Cox 比例风险模型确定心脏和全因死亡率的独立预测因素。
在 9.8±3.5 年的随访期间，411 名（38.9%）参与者死亡，其中 161 名（39.2%）死于心脏原因。心脏死亡的显著正向独立预测因素为年龄、男性、冠心病、脑血管疾病、外周动脉疾病、视网膜病变和周围神经病变（P≤0.004），而母亲糖尿病史具有保护作用（P=0.014）。调整这些变量后，APOE4 携带情况具有预测性（风险比（95%置信区间）为 1.61（1.01-2.58）；P=0.048）。SE 种族也没有作为单一变量或与 APOE4 携带情况的交互项显著增加模型（P≥0.86）。全因死亡率的独立显著预测因素为年龄、男性、吸烟、冠心病、脑血管疾病、外周动脉疾病、视网膜病变、周围神经病变和微量白蛋白尿（P≤0.047），而超重/肥胖、降脂治疗和最近运动具有保护作用（P≤0.008）。APOE4 携带情况、SE 种族及其相互作用并没有增加模型（P≥0.32）。
在澳大利亚社区 2 型糖尿病患者中，SE 种族并没有带来独立的生存优势，但 APOE4 携带者发生心脏死亡的风险更高。
