The Rancho Bernardo Study: 40 years studying why women have less heart disease than men and how diabetes modifies women's usual cardiac protection.
The Rancho Bernardo Study: 40 years studying why women have less heart disease than men and how diabetes modifies women's usual cardiac protection.
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DOI：
10.1016/j.gheart.2012.12.002
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发表时间：
2013-06-01
期刊：
影响因子：
3.7
通讯作者：
Barrett-Connor, Elizabeth
中科院分区：
文献类型：
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作者：
Barrett-Connor, Elizabeth
40年前，很少有心血管疾病（CVD）的队列研究包括女性，更少的研究将糖尿病或糖尿病作为风险因素。我在这里描述的兰乔贝尔纳多研究（RBS），一个单一的网站，>40年的队列研究心脏病的性别差异和糖尿病如何改变妇女的天然心脏保护。对6000多名参与者的发病率和死亡率进行了随访，其中近3000名幸存者（以及>85%的死亡者的死亡证明）。在RBS中，超过一半的糖尿病在没有口服葡萄糖耐量试验（OGTT）的情况下未被诊断;更多的女性比男性有孤立的挑战后高血糖症（IPH）作为糖尿病的唯一葡萄糖证据;男性比女性有更多的糖尿病，空腹血糖水平高于女性，但挑战后血糖水平低于女性;糖尿病女性比男性有更多的经典CVD危险因素;过度的危险因素聚集部分解释了糖尿病如何消除女性的心脏保护作用。挑战后血糖是比空腹血糖更强的心血管疾病风险因素。内源性胰岛素不是女性或男性CVD的独立危险因素。睾酮水平较高的男性患糖尿病的几率较小，代谢综合征的成分也较少。在男性中，较高的总睾酮水平预示着全因和心血管疾病的风险降低，但不是癌症死亡率。在女性中，生物可利用睾酮的两个极端都能预测致命的冠心病，但不能预测全因死亡率。个体数据的大型系统性综述的总结点估计复制了大多数RBS的发现。正在进行的研究可以进一步阐明糖尿病如何改变妇女从中年到老年的心脏保护。
Forty years ago, few cohort studies of cardiovascular disease (CVD) included women and fewer still included diabetes or glycemia as a risk factor. I describe here the Rancho Bernardo Study (RBS), a single-site, >40-year cohort study of sex differences in heart disease and how diabetes modifies women’s natural cardioprotection. More than 6000 participants were followed for morbidity and mortality, with nearly 3000 survivors (and death certificates for >85% of decedents). In RBS more than half of diabetes was undiagnosed without an oral glucose tolerance test (OGTT); more women than men had isolated post-challenge hyperglycemia (IPH) as their only glucose evidence of diabetes; men had more diabetes than women, with higher fasting but lower post-challenge glucose levels than women; women with diabetes had more classical CVD risk factors than men; excess risk-factor clustering partially explained how diabetes eradicates female cardioprotection. Post-challenge glucose was a stronger CVD risk factor than fasting glucose. Endogenous insulin was not an independent CVD risk factor in women or men. Men with higher testosterone levels developed less diabetes and had fewer metabolic syndrome components. In men higher total testosterone levels predicted a reduced risk of all-cause and CVD but not cancer mortality. In women both extremes of bioavailable testosterone predicted fatal coronary heart disease but not all-cause mortality. Summary point estimates from large systematic reviews of individual data have replicated most RBS findings. Ongoing research can further clarify how diabetes modifies women’s cardioprotection from mid-life to old age.