Howard B V, Cowan L D, Go O, Welty T K, Robbins D C, Lee E T
Medlantic Research Institute, Washington, DC 20010-2933, USA.
Diabetes Care. 1998 Aug;21(8):1258-65. doi: 10.2337/diacare.21.8.1258.
Many studies have shown that diabetes increases the risk of cardiovascular disease (CVD) in women to a greater extent than in men. One explanation could be that diabetes has more adverse effects on CVD risk factors in women than in men. We compared diabetes-associated differences in CVD risk factors in men and women in the Strong Heart Study, a population-based study of CVD and its risk factors in American Indians.
A total of 1,846 men and 2,703 women between the ages of 45 and 74 years from 13 American Indian communities in three geographic areas underwent an examination that included a medical history; an electrocardiogram; anthropometric and blood pressure measurements; an oral glucose tolerance test; and measurements of fasting plasma lipoproteins, fibrinogen, insulin, HbA1c, and urinary albumin.
Statistically significantly greater adverse differences in those with diabetes versus those without diabetes were observed in women than in men for waist-to-hip ratio, HDL cholesterol, apolipoprotein (apo)B, apoA1, fibrinogen, and LDL size. In multiple linear regression models adjusting for age, center, sex, and diabetes, the diabetes by sex interaction terms were statistically significant for waist-to-hip ratio, LDL cholesterol, HDL cholesterol, apoB, apoA1, fibrinogen, and LDL size.
Compared with diabetes-associated differences in men, diabetes in women was related to greater adverse differences in levels of several CVD risk factors. Although the magnitude of the individual diabetes-related differences between men and women was not large, the combined effects of these risk factor differences in diabetic women may be substantial. The apparent greater negative impact of diabetes on CVD risk factors in women may explain, in part, the greater risk for CVD in diabetic women.
许多研究表明，糖尿病增加女性心血管疾病（CVD）风险的程度大于男性。一种解释可能是，糖尿病对女性CVD危险因素的不良影响大于男性。我们在强心研究中比较了男性和女性CVD危险因素中与糖尿病相关的差异，该研究是一项基于人群的关于美国印第安人CVD及其危险因素的研究。
来自三个地理区域13个美国印第安社区的1846名年龄在45至74岁之间的男性和2703名女性接受了一项检查，包括病史采集、心电图检查、人体测量和血压测量、口服葡萄糖耐量试验，以及空腹血浆脂蛋白、纤维蛋白原、胰岛素、糖化血红蛋白（HbA1c）和尿白蛋白的测量。
在腰围臀围比、高密度脂蛋白胆固醇、载脂蛋白（apo）B、载脂蛋白A1、纤维蛋白原和低密度脂蛋白大小方面，女性糖尿病患者与非糖尿病患者之间在统计学上的不良差异比男性更为显著。在调整了年龄、中心、性别和糖尿病因素的多元线性回归模型中，性别与糖尿病的交互项在腰围臀围比、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、apoB、apoA1、纤维蛋白原和低密度脂蛋白大小方面具有统计学意义。
与男性中与糖尿病相关的差异相比，女性糖尿病与几种CVD危险因素水平上更大的不良差异有关。尽管男性和女性个体与糖尿病相关的差异幅度不大，但这些危险因素差异在糖尿病女性中的综合作用可能很大。糖尿病对女性CVD危险因素明显更大的负面影响可能部分解释了糖尿病女性患CVD风险更高的原因。
