Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.
Department of Health Statistics, School of Public Health and Management, Weifang Medical University, Shandong, China.
Diabetes Metab Res Rev. 2018 Feb;34(2). doi: 10.1002/dmrr.2960. Epub 2017 Nov 28.
There are inconsistent findings regarding associations between triglyceride levels and cardiovascular disease (CVD) in type 2 diabetes mellitus (T2DM). This study aimed to test whether the association between triglycerides and CVD depends upon duration of diabetes.
From April 1, 2012, to June 30, 2012, we conducted a cross-sectional survey of 223 612 patients with T2DM from 630 hospitals in China. Cardiovascular disease was defined as having either prior coronary heart disease or stroke, or diabetic foot. Binary logistic regression was used to estimate odds ratios of triglyceride for CVD. Relative excess risk due to interaction, attributable proportion due to interaction, and synergy index were used to estimate effect size of additive interaction between low triglyceride, ie, <1.7 mmol/L, and duration of diabetes, ie, ≥15 years.
Among 223 612 T2DM patients, 31 898 (14.27%) suffered from CVD. A low level of triglyceride was associated with decreased risk of CVD (univariable OR, 0.91, 95% CI, 0.88-0.93; multivariable OR, 0.94, 95% CI, 0.92-0.97) among patients with <15 years of duration of diabetes but increased risk of CVD (univariable OR, 1.12, 95% CI, 1.04-1.21; multivariable OR, 1.18, 95% CI, 1.09-1.27) among those patients with 15 and more years of duration of diabetes with significant additive interactions (relative excess risk due to interaction, 0.39, 95% CI, 0.25-0.52; attributable proportion due to interaction, 0.20, 95% CI, 0.14-0.27; and synergy index, 1.80, 95% CI, 1.43-2.28).
Whereas a high triglyceride level was associated with increased risk of CVD in short-term T2DM, low triglyceride was associated with increased CVD risk in long-term T2DM. Low triglyceride may be a marker of CVD risk in Chinese patients with long-term T2DM.
在 2 型糖尿病（T2DM）患者中，甘油三酯水平与心血管疾病（CVD）之间的关联存在不一致的发现。本研究旨在检验甘油三酯与 CVD 之间的关联是否取决于糖尿病的病程。
2012 年 4 月 1 日至 6 月 30 日，我们对中国 630 家医院的 223612 例 T2DM 患者进行了横断面调查。心血管疾病定义为既往有冠心病或卒中，或糖尿病足。采用二项逻辑回归估计甘油三酯与 CVD 的比值比。交互归因比例、交互归因超额比和交互协同指数用于估计低甘油三酯（<1.7mmol/L）和糖尿病病程（≥15 年）之间的相加交互作用的效应大小。
在 223612 例 T2DM 患者中，31898 例（14.27%）患有 CVD。在病程<15 年的患者中，低水平的甘油三酯与 CVD 风险降低相关（单变量 OR，0.91，95%CI，0.88-0.93；多变量 OR，0.94，95%CI，0.92-0.97），但在病程≥15 年的患者中，高甘油三酯与 CVD 风险增加相关（单变量 OR，1.12，95%CI，1.04-1.21；多变量 OR，1.18，95%CI，1.09-1.27），且存在显著的相加交互作用（交互归因超额比，0.39，95%CI，0.25-0.52；交互归因比例，0.20，95%CI，0.14-0.27；协同指数，1.80，95%CI，1.43-2.28）。
在短期 T2DM 中，高甘油三酯水平与 CVD 风险增加相关，而在长期 T2DM 中，低甘油三酯水平与 CVD 风险增加相关。低甘油三酯可能是中国长期 T2DM 患者 CVD 风险的标志物。
