Papademetriou V, Narayan P, Rubins H, Collins D, Robins S
VA Medical Center, Washington, DC 20422, USA.
Am Heart J. 1998 Oct;136(4 Pt 1):734-40. doi: 10.1016/s0002-8703(98)70023-7.
The Veterans Administration-HDL Intervention Trial is an ongoing, 20-center, randomized, double-blind, placebo-controlled study aiming to assess the effect of gemfibrozil-improved low high-density lipoprotein cholesterol levels on cardiovascular morbidity and mortality rates.
Eligible patients were men with low high-density lipoprotein cholesterol levels and demonstrable coronary heart disease. A total of 2531 patients (average age 63.5 years) were randomly assigned in this study, with a mean high-density lipoprotein cholesterol level of 0.83 mmol/L (32 mg/dL) and low-density lipoprotein cholesterol level of 2.87 mmol/L (111 mg/dL). Baseline data provided the opportunity to assess the interaction of several coronary heart disease risk factors and comorbid vascular diseases. Of these patients, 206 had diabetes mellitus (DM) alone, 1021 had hypertension (HTN) alone, 421 had both DM and HTN, and 883 had neither ("others"). Considering the influence of these risk factors on comorbidities independent of smoking status, patients with DM alone had a 2-fold increase in the prevalence of peripheral vascular disease and a 1.5-fold increase in congestive heart failure. Patients with HTN had a significant increase in the prevalence of cerebrovascular disease, stroke, and congestive heart failure. Patients with HTN and DM had a significant increase in all comorbidities. Smoking resulted in substantial increase of both peripheral vascular disease and cerebrovascular disease. Compared with nonsmoking patients with no DM or HTN, patients with DM and HTN and smoking had a 3-fold increase in the prevalence of peripheral vascular disease and a 3.5-fold increase in cerebrovascular disease (P < .001).
We conclude that DM is a strong correlate of peripheral vascular disease, hypertension of cerebrovascular disease, and that there is a strong additive effect between DM, HTN, and smoking on both.
退伍军人管理局高密度脂蛋白干预试验是一项正在进行的、多中心、随机、双盲、安慰剂对照研究，旨在评估吉非贝齐改善低高密度脂蛋白胆固醇水平对心血管发病率和死亡率的影响。
符合条件的患者为高密度脂蛋白胆固醇水平低且患有冠心病的男性。本研究共随机分配了2531例患者（平均年龄63.5岁），平均高密度脂蛋白胆固醇水平为0.83 mmol/L（32 mg/dL），低密度脂蛋白胆固醇水平为2.87 mmol/L（111 mg/dL）。基线数据提供了评估几种冠心病危险因素与合并血管疾病相互作用的机会。在这些患者中，206例仅患有糖尿病（DM），1021例仅患有高血压（HTN），421例同时患有DM和HTN，883例两者均无（“其他”）。考虑到这些危险因素对合并症的影响独立于吸烟状况，仅患有DM的患者外周血管疾病患病率增加2倍，充血性心力衰竭患病率增加1.5倍。患有HTN的患者脑血管疾病、中风和充血性心力衰竭的患病率显著增加。患有HTN和DM的患者所有合并症均显著增加。吸烟导致外周血管疾病和脑血管疾病均大幅增加。与无DM或HTN的非吸烟患者相比，患有DM和HTN且吸烟的患者外周血管疾病患病率增加3倍，脑血管疾病患病率增加3.5倍（P <.001）。
我们得出结论，DM与外周血管疾病密切相关，HTN与脑血管疾病密切相关，并且DM、HTN和吸烟之间对两者均有强烈的叠加效应。
