Burchfiel C M, Hamman R F, Marshall J A, Baxter J, Kahn L B, Amirani J J
Department of Preventive Medicine and Biometrics, University of Colorado School of Medicine, Denver 80262.
Am J Epidemiol. 1990 Jan;131(1):57-70. doi: 10.1093/oxfordjournals.aje.a115485.
Cardiovascular risk factor patterns were examined cross-sectionally in 856 Hispanic and Anglo subjects aged 20-74 years enrolled in the population-based San Luis Valley Diabetes Study of Colorado. Risk factor levels and prevalence were compared for 279 individuals with non-insulin-dependent diabetes mellitus, 89 with impaired glucose tolerance, and 488 with normal glucose tolerance. Sex-specific comparisons of continuous risk factors were made by diabetic status and ethnicity, adjusting for age using two-way analysis of covariance; similar comparisons of discrete variables were made using logistic regression. A number of vascular, metabolic, lipid, obesity-related, family history, and life-style risk factors for cardiovascular disease were examined. In general, biologic risk factors tended to be more strongly associated with diabetic status, while life-style risk factors varied more by ethnicity. Age-adjusted levels of systolic and diastolic blood pressure, hypertension history, triglyceride, and body mass index were lowest among normal subjects, intermediate for those with impaired glucose tolerance, and highest in subjects with non-insulin-dependent diabetes mellitus, while the trend was reversed for high density lipoprotein (HDL) cholesterol and its subfractions. Hispanics had lower serum uric acid levels and greater central obesity than Anglos; they were less likely to have a Type A personality, less physically active at work, and more likely to be a current smoker than Anglos. Hispanic males had a lower body mass index and a higher HDL cholesterol level than Anglo males. These results indicate that an adverse cardiovascular risk factor pattern is present not only in subjects with non-insulin-dependent diabetes mellitus but also in subjects with impaired glucose tolerance who are at increased risk of developing diabetes. This suggests that an adverse risk factor pattern may develop concurrently with or prior to the onset of impaired glucose tolerance. Future prospective studies will help to clarify the temporal sequence involved in the development of adverse cardiovascular risk factor patterns and impaired glucose tolerance.
在科罗拉多州基于人群的圣路易斯谷糖尿病研究中，对856名年龄在20至74岁之间的西班牙裔和盎格鲁族受试者进行了心血管危险因素模式的横断面研究。比较了279名非胰岛素依赖型糖尿病患者、89名糖耐量受损者和488名糖耐量正常者的危险因素水平及患病率。通过糖尿病状态和种族对连续危险因素进行性别特异性比较，并使用双向协方差分析对年龄进行校正；对离散变量进行类似比较时使用逻辑回归。研究了多种心血管疾病的血管、代谢、脂质、肥胖相关、家族史和生活方式危险因素。总体而言，生物学危险因素往往与糖尿病状态的关联更强，而生活方式危险因素在不同种族间的差异更大。正常受试者的年龄校正收缩压和舒张压水平、高血压病史、甘油三酯和体重指数最低，糖耐量受损者居中，非胰岛素依赖型糖尿病患者最高，而高密度脂蛋白（HDL）胆固醇及其亚组分的趋势则相反。西班牙裔的血清尿酸水平较低，中心性肥胖程度高于盎格鲁族；与盎格鲁族相比，他们A型人格的可能性较小，工作时身体活动较少，当前吸烟者的可能性更大。西班牙裔男性的体重指数低于盎格鲁族男性，HDL胆固醇水平高于盎格鲁族男性。这些结果表明，不良的心血管危险因素模式不仅存在于非胰岛素依赖型糖尿病患者中，也存在于糖耐量受损且患糖尿病风险增加的受试者中。这表明不良危险因素模式可能在糖耐量受损发生之前或同时出现。未来的前瞻性研究将有助于阐明不良心血管危险因素模式和糖耐量受损发展过程中的时间顺序。
