Masmiquel L, Leiter L A, Vidal J, Bain S, Petrie J, Franek E, Raz I, Comlekci A, Jacob S, van Gaal L, Baeres F M M, Marso S P, Eriksson M
Endocrinology and Nutrition Department, Hospital Son Llàtzer, University Institute of Health Science Research (IUNICS-IdISPa), Universitat de les Illes Balears, Palma, Majorca, Spain.
Divisions of Endocrinology and Metabolism, Li Ka Shing Knowledge Institute and Keenan Research Centre for Biomedical Science, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
Cardiovasc Diabetol. 2016 Feb 10;15:29. doi: 10.1186/s12933-016-0341-5.
Epidemiological data on obesity are needed, particularly in patients with type 2 diabetes mellitus (T2DM) and high cardiovascular (CV) risk. We used the baseline data of liraglutide effect and action in diabetes: evaluation of CV outcome results-A long term Evaluation (LEADER) (a clinical trial to assess the CV safety of liraglutide) to investigate: (i) prevalence of overweight and obesity; (ii) relationship of the major cardiometabolic risk factors with anthropometric measures of adiposity [body mass index (BMI) and waist circumference (WC)]; and (iii) cardiometabolic treatment intensity in relation to BMI and WC.
LEADER enrolled two distinct populations of high-risk patients with T2DM in 32 countries: (1) aged ≥50 years with prior CV disease; (2) aged ≥60 years with one or more CV risk factors. Associations of metabolic variables, demographic variables and treatment intensity with anthropometric measurements (BMI and WC) were explored using regression models (ClinicalTrials.gov identifier: NCT01179048).
Mean BMI was 32.5 ± 6.3 kg/m(2) and only 9.1 % had BMI <25 kg/m(2). The prevalence of healthy WC was also extremely low (6.4 % according to International Joint Interim Statement for the Harmonization of the Metabolic Syndrome criteria). Obesity was associated with being younger, female, previous smoker, Caucasian, American, with shorter diabetes duration, uncontrolled blood pressure (BP), antihypertensive agents, insulin plus oral antihyperglycaemic treatment, higher levels of triglycerides and lower levels of high-density lipoprotein cholesterol.
Overweight and obesity are prevalent in high CV risk patients with T2DM. BMI and WC are related to the major cardiometabolic risk factors. Furthermore, treatment intensity, such as insulin, statins or oral antihypertensive drugs, is higher in those who are overweight or obese; while BP and lipid control in these patients are remarkably suboptimal. LEADER confers a unique opportunity to explore the longitudinal effect of weight on CV risk factors and hard endpoints.
需要有关肥胖的流行病学数据，尤其是2型糖尿病（T2DM）和心血管（CV）高风险患者的数据。我们使用了利拉鲁肽在糖尿病中的疗效和作用：心血管结局结果评估-长期评估（LEADER）（一项评估利拉鲁肽心血管安全性的临床试验）的基线数据来调查：（i）超重和肥胖的患病率；（ii）主要心血管代谢危险因素与肥胖人体测量指标[体重指数（BMI）和腰围（WC）]之间的关系；以及（iii）与BMI和WC相关的心血管代谢治疗强度。
LEADER在32个国家招募了两个不同的T2DM高危患者群体：（1）年龄≥50岁且有既往心血管疾病；（2）年龄≥60岁且有一个或多个心血管危险因素。使用回归模型（ClinicalTrials.gov标识符：NCT01179048）探索代谢变量、人口统计学变量和治疗强度与人体测量指标（BMI和WC）之间的关联。
平均BMI为32.5±6.3kg/m²，只有9.1%的人BMI<25kg/m²。健康WC的患病率也极低（根据国际代谢综合征标准协调联合临时声明为6.4%）。肥胖与年龄较小、女性、既往吸烟者、白种人、美国人、糖尿病病程较短、血压（BP）未控制、使用抗高血压药物、胰岛素加口服降糖治疗、甘油三酯水平较高和高密度脂蛋白胆固醇水平较低有关。
超重和肥胖在T2DM心血管高风险患者中普遍存在。BMI和WC与主要心血管代谢危险因素有关。此外，超重或肥胖者的胰岛素、他汀类药物或口服抗高血压药物等治疗强度较高；而这些患者的血压和血脂控制明显欠佳。LEADER为探索体重对心血管危险因素和硬性终点的纵向影响提供了独特的机会。
