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脂蛋白(a)浓度在性别特异性差异与 2 型糖尿病患者心血管死亡率的关系。

Association of sex-specific differences in lipoprotein(a) concentrations with cardiovascular mortality in individuals with type 2 diabetes mellitus.

机构信息

Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.

German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany.

出版信息

Cardiovasc Diabetol. 2021 Aug 18;20(1):168. doi: 10.1186/s12933-021-01363-x.

DOI:10.1186/s12933-021-01363-x
PMID:34407812
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8375146/
Abstract

BACKGROUND: Compared to individuals without type 2 diabetes mellitus, the relative increase in cardiovascular mortality is much higher in women than in men in individuals with type 2 diabetes mellitus. METHODS: We evaluated data from 7443 individuals (3792 women, 50.9%), aged 20 to 81 years, from two independent population-based investigations, SHIP-0 and MONICA/KORA S3. We analyzed the longitudinal sex-specific associations of lipoprotein(a) with cardiovascular mortality in individuals with and without type 2 diabetes mellitus using Cox regression. RESULTS: During a median follow-up of 20.5 years (136,802 person-years), 657 participants (404 men and 253 women) died of cardiovascular causes. Among individuals without type 2 diabetes mellitus, men had a significantly higher risk for cardiovascular mortality compared to women in unadjusted model and after adjustment. On the other hand, in participants with type 2 diabetes mellitus, the risk for cardiovascular mortality was not different between men and women in the unadjusted model and after adjustment for age, body mass index, low-density lipoprotein-cholesterol, fasting status and study sample (SHIP-0, MONICA/KORA S3). Further adjustment for lipoprotein(a) concentrations had no impact on the hazard ratio (HR) for cardiovascular mortality comparing men versus women in individuals without type 2 diabetes mellitus [HR: 1.94; 95% confidence interval (CI) 1.63 to 2.32; p < 0.001]. In individuals with type 2 diabetes mellitus, however, further adjustment for lipoprotein(a) led to an increased risk for cardiovascular mortality in men and a decreased risk in women resulting in a statistically significant difference between men and women (HR: 1.53; 95% CI 1.04 to 2.24; p = 0.029). CONCLUSIONS: Women are described to have a stronger relative increase in cardiovascular mortality than men when comparing individuals with and without type 2 diabetes mellitus. Higher lipoprotein(a) concentrations in women with type 2 diabetes mellitus than in men with type 2 diabetes mellitus might partially explain this finding.

摘要

背景：与没有 2 型糖尿病的个体相比，2 型糖尿病个体的心血管死亡率的相对增加在女性中比男性更高。

方法：我们评估了来自两个独立的基于人群的调查（SHIP-0 和 MONICA/KORA S3）的 7443 名个体（3792 名女性，占 50.9%）的数据。我们使用 Cox 回归分析了脂蛋白（a）与有和没有 2 型糖尿病的个体心血管死亡率的纵向性别特异性关联。

结果：在中位随访 20.5 年（136802 人年）期间，有 657 名参与者（404 名男性和 253 名女性）死于心血管原因。在没有 2 型糖尿病的个体中，男性在未经调整的模型和调整后的模型中，心血管死亡率的风险均显著高于女性。另一方面，在患有 2 型糖尿病的参与者中，在未经调整的模型和调整年龄、体重指数、低密度脂蛋白胆固醇、空腹状态和研究样本（SHIP-0、MONICA/KORA S3）后，男性和女性的心血管死亡率风险无差异。进一步调整脂蛋白（a）浓度对无 2 型糖尿病个体中男性与女性心血管死亡率的危险比（HR）没有影响[HR：1.94；95%置信区间（CI）1.63 至 2.32；p<0.001]。然而，在患有 2 型糖尿病的个体中，进一步调整脂蛋白（a）导致男性的心血管死亡率风险增加，女性的风险降低，导致男性和女性之间存在统计学显著差异（HR：1.53；95%CI 1.04 至 2.24；p=0.029）。

结论：与没有 2 型糖尿病的个体相比，在比较有和没有 2 型糖尿病的个体时，女性描述为心血管死亡率的相对增加更强。与男性相比，患有 2 型糖尿病的女性脂蛋白（a）浓度更高，这可能部分解释了这一发现。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9d85/8375146/7d7e0b196473/12933_2021_1363_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9d85/8375146/5e782d84df32/12933_2021_1363_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9d85/8375146/6fdd80c4a790/12933_2021_1363_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9d85/8375146/7d7e0b196473/12933_2021_1363_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9d85/8375146/5e782d84df32/12933_2021_1363_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9d85/8375146/6fdd80c4a790/12933_2021_1363_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9d85/8375146/7d7e0b196473/12933_2021_1363_Fig3_HTML.jpg

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[3]
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[4]
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Int J Gen Med. 2023-8-8

[5]
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[6]
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Lipids Health Dis. 2022-12-19

[7]
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[8]
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[9]
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本文引用的文献

[1]
Small dense low-density lipoprotein-cholesterol (sdLDL-C): Analysis, effects on cardiovascular endpoints and dietary strategies.

Prog Cardiovasc Dis. 2020-4-27

[2]
Lipoprotein(a): is it more, less or equal to LDL as a causal factor for cardiovascular disease and mortality?

Curr Opin Lipidol. 2020-6

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Eur Heart J. 2020-4-1

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Prog Cardiovasc Dis. 2019-8-20

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Eur Heart J. 2020-6-21

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Clin Ther. 2019-7-13

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Mayo Clin Proc. 2019-2

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High lipoprotein(a) and high risk of mortality.

Eur Heart J. 2019-9-1

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Sex-specific relevance of diabetes to occlusive vascular and other mortality: a collaborative meta-analysis of individual data from 980 793 adults from 68 prospective studies.

Lancet Diabetes Endocrinol. 2018-5-8

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