英国的无症状高血糖与重大缺血性心脏病事件

Asymptomatic hyperglycaemia and major ischaemic heart disease events in Britain.

作者信息

Perry I J, Wannamethee S G, Whincup P H, Shaper A G

机构信息

Department of Public Health, Royal Free Hospital School of Medicine, London.

出版信息

J Epidemiol Community Health. 1994 Dec;48(6):538-42. doi: 10.1136/jech.48.6.538.

DOI:10.1136/jech.48.6.538

PMID:7830006

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1060028/

Abstract

OBJECTIVE

To examine the association between non-fasting serum glucose concentrations and major ischaemic heart disease (IHD) events (fatal and non-fatal myocardial infarction).

DESIGN

A prospective study.

SUBJECTS

A population based sample of 7735 middle aged British men. Known diabetics, men with a glucose concentration > or = 11.1 mmol/l at screening, and hypertensive patients taking regular medication were excluded from the analysis. With exclusions (n = 509) and missing glucose values (n = 49), there were 7177 men available for analysis.

MAIN OUTCOME MEASURES

Major IHD events (fatal and non-fatal myocardial infarction) during 9.5 years follow up on all men.

RESULTS

There were 505 major IHD events, 222 fatal and 283 non-fatal, in the 7177 men studied. There was a non-linear relation between the glucose concentration and the risk (per 1000 men per year) of all major IHD events and fatal IHD events, with the excess risk in the upper quintile of the glucose distribution (> or = 6.1 mmol/l). The unadjusted relative risks (RR) in the upper glucose concentration quintile compared with the first to the fourth quintiles combined were 1.4 (95% CI 1.1, 1.7) for all events and 1.3 (95% CI 1.0, 1.7) for fatal events. Adjustment for age, smoking, occupational status, body mass index, physical activity, systolic blood pressure, total and high density lipoprotein cholesterol, and triglyceride concentrations had a minimal effect on these relative risk estimates. This non-linear relationship between the serum glucose concentration and the risk of a major IHD event was observed in men with no evidence of IHD at screening (n = 5518) but not in men with IHD (n = 1659). In the former group, the RR (adjusted for major coronary risk factors) for all major IHD events in the upper quintile relative to the lower quintiles combined was 1.5 (95% CI 1.2, 2.0) and for fatal IHD events was 1.8 (95% CI 1.1, 2.6).

CONCLUSION

These data suggest that asymptomatic hyperglycaemia is an independent risk factor for major IHD events.

摘要

目的

研究非空腹血清葡萄糖浓度与主要缺血性心脏病（IHD）事件（致命和非致命性心肌梗死）之间的关联。

设计

一项前瞻性研究。

研究对象

基于人群的7735名英国中年男性样本。分析中排除了已知糖尿病患者、筛查时血糖浓度≥11.1 mmol/l的男性以及正在服用常规药物的高血压患者。排除（n = 509）和血糖值缺失（n = 49）后，有7177名男性可供分析。

主要观察指标

对所有男性进行9.5年随访期间的主要IHD事件（致命和非致命性心肌梗死）。

结果

在研究的7177名男性中，有505例主要IHD事件，其中222例致命，283例非致命。血糖浓度与所有主要IHD事件和致命IHD事件的风险（每1000名男性每年）之间存在非线性关系，在血糖分布的上五分位数（≥6.1 mmol/l）中风险增加。与第一至第四五分位数合并相比，血糖浓度上五分位数的未调整相对风险（RR）对于所有事件为1.4（95%CI 1.1，1.7），对于致命事件为1.3（95%CI 1.0，1.7）。对年龄、吸烟、职业状况、体重指数、身体活动、收缩压、总胆固醇和高密度脂蛋白胆固醇以及甘油三酯浓度进行调整后，对这些相对风险估计值的影响极小。在筛查时无IHD证据的男性（n = 5518）中观察到血清葡萄糖浓度与主要IHD事件风险之间的这种非线性关系，但在有IHD的男性（n = 1659）中未观察到。在前一组中，相对于较低五分位数合并，上五分位数中所有主要IHD事件的RR（根据主要冠状动脉危险因素调整）为1.5（95%CI 1.2，2.0），致命IHD事件的RR为1.8（95%CI 1.1，2.6）。