Meigs J B, Singer D E, Sullivan L M, Dukes K A, D'Agostino R B, Nathan D M, Wagner E H, Kaplan S H, Greenfield S
General Internal Medicine Unit, Massachusetts General Hospital, Boston 02114, USA.
Am J Med. 1997 Jan;102(1):38-47. doi: 10.1016/s0002-9343(96)00383-x.
Cardiovascular disease is a major cause of morbidity and death in non-insulin-dependent diabetes mellitus (NIDDM). While hyperglycemia is clearly related to diabetic microvascular complications, it contribution to large-vessel atherosclerosis is controversial.
We performed an analysis of the association between glycemic control and prevalent cardiovascular disease in 1,539 participants in the NIDDM Patient Outcomes Research Team study who were under usual care in a health maintenance organization. Prevalent cardiovascular disease and its risk factors were identified by self-administered questionnaire. Cardiovascular disease was defined by the presence of coronary heart disease, peripheral vascular disease, and/or cerebrovascular disease. Glycohemoglobin and lipid levels were obtained from a computerized laboratory database.
The mean age of participants was 63 years (range 31 to 91); 51% were women. The mean duration of NIDDM was 9 years (range < 1 to 50), 35% took insulin, and 48% took sulfonylureas. Mean glycohemoglobin was 10.6%. Sixty percent had hypertension, 16% currently smoked cigarettes, and the mean total high-density lipoprotein (HDL) cholesterol ratio was 5.7. Fifty-one percent had cardiovascular disease. Cardiovascular disease prevalence remained constant across increasing quartiles of glycohemoglobin for both men and women. In contrast, prevalent cardiovascular disease was associated with established cardiovascular disease risk factors including age (67 versus 59 years, P < 0.0001), hypertension (66% versus 54%, P < 0.0001), current cigarette smoking (17% versus 13%, P < 0.005), and total/HDL cholesterol ratio (5.9 versus 5.6, P < 0.005). Cardiovascular disease was also associated with duration of NIDDM (11 versus 8 years, P < 0.0001). In multiple logistic regression analysis controlling for established cardiovascular disease risk factors and diabetes duration and therapy, glycohemoglobin remained unassociated with cardiovascular disease.
Glycemic control is not associated with prevalent cardiovascular disease in this large population of individuals with NIDDM. Conventional cardiovascular disease risk factors are independently associated with cardiovascular disease and be a more promising focus for clinical intervention to reduce atherosclerotic complications in NIDDM.
心血管疾病是非胰岛素依赖型糖尿病（NIDDM）发病和死亡的主要原因。虽然高血糖与糖尿病微血管并发症明显相关，但其对大血管动脉粥样硬化的影响仍存在争议。
我们对NIDDM患者转归研究小组研究中的1539名参与者进行了血糖控制与心血管疾病患病率之间关联的分析，这些参与者在一家健康维护组织接受常规治疗。通过自行填写问卷确定心血管疾病患病率及其危险因素。心血管疾病定义为存在冠心病、外周血管疾病和/或脑血管疾病。糖化血红蛋白和血脂水平从计算机化实验室数据库中获取。
参与者的平均年龄为63岁（范围31至91岁）；51%为女性。NIDDM的平均病程为9年（范围<1至50年），35%使用胰岛素，48%使用磺脲类药物。平均糖化血红蛋白为10.6%。60%患有高血压，16%当前吸烟，平均总高密度脂蛋白（HDL）胆固醇比值为5.7。51%患有心血管疾病。男性和女性的心血管疾病患病率在糖化血红蛋白四分位数增加时保持不变。相比之下，心血管疾病患病率与已确定的心血管疾病危险因素相关，包括年龄（67岁对59岁，P<0.0001）、高血压（66%对54%，P<0.0001）、当前吸烟（17%对13%，P<0.005）以及总胆固醇/HDL胆固醇比值（5.9对5.6，P<0.005）。心血管疾病还与NIDDM病程相关（11年对8年，P<0.0001）。在控制已确定的心血管疾病危险因素、糖尿病病程和治疗的多因素逻辑回归分析中，糖化血红蛋白与心血管疾病仍无关联。
在这一大量NIDDM个体人群中，血糖控制与心血管疾病患病率无关。传统心血管疾病危险因素与心血管疾病独立相关，可能是降低NIDDM动脉粥样硬化并发症临床干预更有前景的重点。
