Uusitupa M I, Niskanen L K, Siitonen O, Voutilainen E, Pyörälä K
Department of Clinical Nutrition, University of Kuopio, Finland.
Diabetologia. 1993 Nov;36(11):1175-84. doi: 10.1007/BF00401063.
The purpose of the present study was to examine 10-year cardiovascular morbidity and mortality in patients with newly-diagnosed Type 2 (non-insulin-dependent) diabetes mellitus and non-diabetic control subjects and to evaluate the effects of general risk factors, plasma insulin, urinary albumin excretion, lipoprotein abnormalities characteristic of Type 2 diabetes and the degree of hyperglycaemia in diabetic patients on cardiovascular mortality. Furthermore, the extent to which the above-mentioned factors could contribute to the excessive cardiovascular mortality observed in diabetic patients was examined. In the years 1979-1981, altogether 133 (70 men, 63 women) newly-diagnosed patients with Type 2 diabetes and 144 (62 men, 82 women) non-diabetic control subjects aged 45-64 years were studied. Both groups were re-examined in the years 1985-1986 and 1991-1992. The impact of different factors on cardiovascular mortality was examined by univariate analyses after adjustment for age and sex and by multiple logistic regression analyses. The age-standardized total and cardiovascular mortality rates were substantially higher in diabetic men (17.8 and 15.0%, total and cardiovascular mortality, respectively p = 0.06 and NS) and women (18.5 and 16.6%, p < 0.01 for both) than in non-diabetic control men (5.2% both total and cardiovascular mortality) and women (4.2 and 2.2%). Cardiovascular mortality was not related to the treatment modality (diet, oral drugs, insulin) at 5 years from diagnosis. Use of diuretics, beta-blocking agents or their combination at baseline did not make a significant contribution to cardiovascular mortality either. In multiple logistic regression analysis on diabetic patients, age, LDL triglycerides, smoking, blood glucose and ischaemic ECG at baseline had independent associations with cardiovascular mortality. Interestingly, urinary albumin excretion rate measured at 5-year examination also predicted 10-year cardiovascular mortality after adjustment for the effects of major risk factors including lipoprotein abnormalities, but its predictive power reduced to a nonsignificant level when the effect of plasma glucose was taken into account. The relative risk of cardiovascular mortality associated with diabetes was 8.2 after allowing for age alone, but it declined to 3.7 when all contributing factors from the baseline examination (except blood glucose) were taken into account. In conclusion, the present results indicate that LDL triglycerides and/or other changes in lipoprotein composition characteristic of Type 2 diabetes and manifesting as elevated serum triglycerides are atherogenic and they strongly predict increased cardiovascular mortality.(ABSTRACT TRUNCATED AT 400 WORDS)
本研究的目的是调查新诊断的2型（非胰岛素依赖型）糖尿病患者和非糖尿病对照者10年心血管疾病的发病率和死亡率，并评估一般危险因素、血浆胰岛素、尿白蛋白排泄、2型糖尿病特有的脂蛋白异常以及糖尿病患者高血糖程度对心血管死亡率的影响。此外，还研究了上述因素在多大程度上可能导致糖尿病患者心血管死亡率过高。在1979 - 1981年期间，共研究了133例（70名男性，63名女性）新诊断的2型糖尿病患者和144例（62名男性，82名女性）年龄在45 - 64岁的非糖尿病对照者。两组在1985 - 1986年和1991 - 1992年进行了再次检查。通过在调整年龄和性别后的单因素分析以及多因素逻辑回归分析来研究不同因素对心血管死亡率的影响。年龄标准化的总死亡率和心血管死亡率在糖尿病男性（分别为17.8%和15.0%，总死亡率和心血管死亡率，p = 0.06和无显著性差异）和女性（分别为18.5%和16.6%，两者p < 0.01）中显著高于非糖尿病对照男性（总死亡率和心血管死亡率均为5.2%）和女性（分别为4.2%和2.2%）。从诊断起5年时，心血管死亡率与治疗方式（饮食、口服药物、胰岛素）无关。基线时使用利尿剂、β受体阻滞剂或其联合使用对心血管死亡率也没有显著影响。在对糖尿病患者的多因素逻辑回归分析中，年龄、低密度脂蛋白甘油三酯、吸烟、血糖和基线时的缺血性心电图与心血管死亡率有独立关联。有趣的是，在5年检查时测量的尿白蛋白排泄率在调整包括脂蛋白异常在内的主要危险因素的影响后，也能预测10年心血管死亡率，但当考虑血浆葡萄糖的影响时，其预测能力降至无显著性水平。仅考虑年龄时，与糖尿病相关的心血管死亡率相对风险为8.2，但当考虑基线检查的所有相关因素（血糖除外）时，该风险降至3.7。总之，目前的结果表明，2型糖尿病特有的低密度脂蛋白甘油三酯和/或脂蛋白组成的其他变化（表现为血清甘油三酯升高）具有致动脉粥样硬化作用，并且强烈预测心血管死亡率增加。（摘要截选至400字）
