Costacou T, Evans R W, Orchard T J
Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
Diabet Med. 2016 Nov;33(11):1524-1527. doi: 10.1111/dme.13127. Epub 2016 Apr 20.
We aimed to assess whether the association of the haptoglobin 2 allele with coronary artery disease is modified by glycaemic control in a prospective cohort study of individuals with childhood-onset Type 1 diabetes.
Coronary artery disease events (death from coronary artery disease, confirmed myocardial infarction, stenosis ≥50%, revascularization) were assessed between 1986 and 2013 among 480 individuals with Type 1 diabetes (baseline age 28 years; diabetes duration 19 years). Better glycaemic control was defined as an updated mean HbA during follow-up of <8% (64 mmol/mol).
In crude models, the incidence of coronary artery disease increased with the number of haptoglobin 2 alleles (hazard ratio 1.34, 95% CI 1.05-1.71). This association was more pronounced in those with better than in those with worse glycaemic control (P interaction = 0.05) and remained essentially unaltered after multivariable adjustments (hazard ratio 2.65, 95% CI 1.30-5.41 in those with better glycaemic control and hazard ratio 1.20, 95% CI 0.93-1.56 in those with worse glycaemic control).
These results suggest that, although better control may reduce the incidence of coronary artery disease in Type 1 diabetes, a residual risk related to the haptoglobin 2 allele remains.
在一项针对儿童期发病的1型糖尿病患者的前瞻性队列研究中，我们旨在评估血糖控制是否会改变触珠蛋白2等位基因与冠状动脉疾病之间的关联。
在1986年至2013年期间，对480名1型糖尿病患者（基线年龄28岁；糖尿病病程19年）的冠状动脉疾病事件（冠状动脉疾病死亡、确诊心肌梗死、狭窄≥50%、血运重建）进行了评估。更好的血糖控制定义为随访期间更新的平均糖化血红蛋白<8%（64 mmol/mol）。
在粗略模型中，冠状动脉疾病的发病率随着触珠蛋白2等位基因数量的增加而升高（风险比1.34，95%置信区间1.05-1.71）。这种关联在血糖控制较好的患者中比在血糖控制较差的患者中更为明显（P交互作用=0.05），并且在多变量调整后基本保持不变（血糖控制较好的患者风险比2.65，95%置信区间1.30-5.41；血糖控制较差的患者风险比1.20，95%置信区间0.93-1.56）。
这些结果表明，尽管更好的血糖控制可能会降低1型糖尿病患者冠状动脉疾病的发病率，但与触珠蛋白2等位基因相关的残余风险仍然存在。
