Cowie C C, Howard B V, Harris M I
Social and Scientific Systems, Inc., Bethesda, Md 20814.
Circulation. 1994 Sep;90(3):1185-93. doi: 10.1161/01.cir.90.3.1185.
Despite the significant role that dyslipidemia is believed to play in the development of cardiovascular disease in diabetes, most studies examining diabetic dyslipidemia in the United States have not been population based, and very little data are available for African Americans with diabetes. We used data from a national survey to compare the effect of diabetes on lipid concentrations in African-American and white men and women. In addition, we examined other factors related to lipid concentrations and controlled for these factors in our analyses.
The Second National Health and Nutrition Examination Survey included a representative sample of 4177 African Americans and whites in the US civilian noninstitutionalized population 20 to 74 years old. These persons were classified as having non-insulin-dependent diabetes mellitus (NIDDM) (n = 720) or as being nondiabetic (n = 3457) based on an oral glucose tolerance test and a medical history of diabetes. Subjects were given an interview and physical examination that included measurement of serum lipoproteins, body mass index, body fat distribution, dietary fat intake, alcohol consumption, frequency of smoking, and use of medications. By univariate analysis, a worse profile of mean cholesterol, triglycerides, and high-density lipoprotein cholesterol levels was generally apparent in NIDDM than in nondiabetic subjects, regardless of race or sex; a similar pattern was found for the prevalence of abnormal concentrations of these lipids. Lipid profiles appeared to be worse in whites with NIDDM than in African Americans. For mean total and low-density lipoprotein cholesterol, concentrations tended to be worse in women with NIDDM than in men. When other factors significantly affecting lipid levels were adjusted by multivariate analysis, we found that in all race/sex groups, total cholesterol was higher in NIDDM than in nondiabetic subjects but differences were not significant (P = 54), triglyceride concentrations were significantly higher in NIDDM subjects (P < .0001), and high-density lipoprotein cholesterol concentrations were lower in NIDDM subjects (P = .003). An interaction of diabetes with race was found for low-density lipoprotein cholesterol (P = .0001), where concentrations were substantially lower in NIDDM than in nondiabetic subjects among African Americans (P < .01) but slightly higher in NIDDM subjects among whites (P = .33). For other lipids, no differential effect of NIDDM was found by race or sex.
In African-American and white men and women in the United States, NIDDM is associated with a pattern of dyslipidemia that may potentiate the atherosclerotic process. Diabetic treatment should include aggressive treatment of dyslipidemia to reduce this increased risk.
尽管血脂异常被认为在糖尿病患者心血管疾病的发生中起重要作用，但美国大多数关于糖尿病血脂异常的研究并非基于人群，且针对非裔美国糖尿病患者的数据非常有限。我们利用一项全国性调查的数据，比较糖尿病对非裔美国人和白人男性及女性血脂浓度的影响。此外，我们还研究了与血脂浓度相关的其他因素，并在分析中对这些因素进行了控制。
第二次全国健康与营养检查调查纳入了美国20至74岁非机构化平民人口中4177名非裔美国人和白人的代表性样本。根据口服葡萄糖耐量试验和糖尿病病史，这些人被分类为患有非胰岛素依赖型糖尿病（NIDDM）（n = 720）或非糖尿病患者（n = 3457）。对受试者进行了访谈和体格检查，包括测量血清脂蛋白、体重指数、体脂分布、膳食脂肪摄入量、酒精摄入量、吸烟频率和药物使用情况。通过单因素分析，无论种族或性别，NIDDM患者的平均胆固醇、甘油三酯和高密度脂蛋白胆固醇水平通常比非糖尿病患者更差；这些血脂异常浓度的患病率也呈现类似模式。NIDDM白人患者的血脂谱似乎比非裔美国人更差。对于平均总胆固醇和低密度脂蛋白胆固醇，NIDDM女性患者的浓度往往比男性更差。当通过多因素分析调整其他显著影响血脂水平的因素后，我们发现，在所有种族/性别组中，NIDDM患者的总胆固醇高于非糖尿病患者，但差异不显著（P = 0.54），NIDDM患者的甘油三酯浓度显著更高（P < 0.0001），而NIDDM患者的高密度脂蛋白胆固醇浓度更低（P = 0.003）。发现糖尿病与种族在低密度脂蛋白胆固醇方面存在交互作用（P = 0.0001），在非裔美国人中，NIDDM患者的低密度脂蛋白胆固醇浓度显著低于非糖尿病患者（P < 0.01），而在白人NIDDM患者中则略高（P = 0.33）。对于其他血脂，未发现NIDDM在种族或性别上有差异效应。
在美国的非裔美国人和白人男性及女性中，NIDDM与一种可能增强动脉粥样硬化进程的血脂异常模式相关。糖尿病治疗应包括积极治疗血脂异常以降低这种增加的风险。
