Rehabilitation Center, Aizawa Hospital.
J Atheroscler Thromb. 2012;19(10):918-23. doi: 10.5551/jat.13334. Epub 2012 Aug 1.
To identify predictors of coronary heart disease (CHD) in Japanese patients with type 2 diabetes (T2DM).
A matched case-control study was performed using 800 patients with T2DM admitted for treatment of hyperglycemia from January 2002 to June 2010. Cases comprised 16 patients who had developed acute myocardial infarction and/or received a coronary artery bypass by June 2010, and controls comprised 48 age- and sex-matched patients without CHD events. The mean age, glycated hemoglobin (HbA1c), and body mass index (BMI) were 61.5 yrs, 9.7% and 24.4 kg/m(2), respectively. The relationship of baseline variables, including lipid values, HbA1c, BMI, blood pressure, fasting blood sugar, 2h-post-breakfast blood sugar, delta blood sugar(0-2h), urinary albumin excretion, estimated glomerular filtration rate and treatment modalities (insulin/sulfonylurea/biguanide), to CHD development was analyzed by conditional logistic regression analysis.
Total cholesterol (TC) (OR 2.35, 95%CI 1.11-4.98, p=0.03), non-HDL-cholesterol (OR 3.07, 95%CI 1.33-7.10, p=0.009), LDL-cholesterol (OR 2.84, 95%CI 1.24-6.51, p=0.01), non-HDL-cholesterol/HDL-cholesterol (OR 2.07, 95%CI 1.10-3.90, p=0.02) and LDL-cholesterol/ HDL-cholesterol (OR 2.74, 95%CI 1.22-6.15, p=0.01) were significantly related to CHD. Fold risk increment per 1-SD increase in basal TC, non-HDL-cholesterol, LDL-cholesterol, non-HDL-cholesterol/HDL-cholesterol and LDL-cholesterol/HDL-cholesterol was 2.33, 2.89, 2.52, 2.37 and 2.60, respectively. Only non-HDL-cholesterol was an independent risk factor. From the receiver operating characteristic curve, 3.89 mmol/L non-HDL-C was the best cutoff value. None of the non-lipid variables were significantly related to CHD.
Non-HDL-cholesterol was the most dominant predictor of the development of CHD in Japanese patients with T2DM.
确定日本 2 型糖尿病（T2DM）患者冠心病（CHD）的预测因素。
采用病例对照研究，选取 2002 年 1 月至 2010 年 6 月因高血糖入院治疗的 800 例 T2DM 患者。病例组包括 16 例在 2010 年 6 月前发生急性心肌梗死和/或接受冠状动脉旁路移植术的患者，对照组包括 48 例年龄和性别匹配且无 CHD 事件的患者。患者的平均年龄、糖化血红蛋白（HbA1c）和体重指数（BMI）分别为 61.5 岁、9.7%和 24.4kg/m²。采用条件 logistic 回归分析方法分析基线变量（包括血脂值、HbA1c、BMI、血压、空腹血糖、早餐后 2 小时血糖、0-2 小时血糖差值、尿白蛋白排泄率、估算肾小球滤过率和治疗方式（胰岛素/磺脲类/二甲双胍））与 CHD 发展之间的关系。
总胆固醇（TC）（OR 2.35，95%CI 1.11-4.98，p=0.03）、非高密度脂蛋白胆固醇（OR 3.07，95%CI 1.33-7.10，p=0.009）、低密度脂蛋白胆固醇（OR 2.84，95%CI 1.24-6.51，p=0.01）、非高密度脂蛋白胆固醇/高密度脂蛋白胆固醇（OR 2.07，95%CI 1.10-3.90，p=0.02）和低密度脂蛋白胆固醇/高密度脂蛋白胆固醇（OR 2.74，95%CI 1.22-6.15，p=0.01）与 CHD 显著相关。基础 TC、非高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、非高密度脂蛋白胆固醇/高密度脂蛋白胆固醇和低密度脂蛋白胆固醇/高密度脂蛋白胆固醇每增加 1-SD，CHD 的风险增加倍数分别为 2.33、2.89、2.52、2.37 和 2.60。只有非高密度脂蛋白胆固醇是独立的危险因素。从受试者工作特征曲线来看，3.89mmol/L 非高密度脂蛋白胆固醇是非高密度脂蛋白胆固醇的最佳截断值。非脂质变量均与 CHD 无显著相关性。
非高密度脂蛋白胆固醇是日本 2 型糖尿病患者发生 CHD 的最主要预测因素。
