High-Sensitivity C-Reactive Protein Is Associated With Incident Type 2 Diabetes Among African Americans: The Jackson Heart Study.
High-Sensitivity C-Reactive Protein Is Associated With Incident Type 2 Diabetes Among African Americans: The Jackson Heart Study.
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DOI：
10.2337/dc15-0221
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发表时间：
2015-09
期刊：
影响因子：
16.2
通讯作者：
Bertoni AG
中科院分区：
文献类型：
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作者：
Effoe VS;Correa A;Chen H;Lacy ME;Bertoni AG
以前关于hs-CRP与非裔美国人2型糖尿病发病率之间关系的研究尚未得出结论。我们在一个大型的非裔美国人队列中（杰克逊心脏研究）检测了超敏C反应蛋白与糖尿病发病之间的关系。在3,340名参与者中测量了hs-CRP。事件糖尿病定义为随访时空腹血糖≥126 mg/dL、医生诊断、使用糖尿病药物或A1 C ≥6.5%（48 mmol/mol）。采用考克斯回归法估计糖尿病发病的风险比（HR），校正年龄、性别、教育、糖尿病家族史、酒精、HDL、甘油三酯、高血压状态、高血压药物、体力活动、BMI、HOMA-胰岛素抵抗（HOMAIR）和腰围。参与者（63%为女性）年龄为53.3 ± 12.5岁。在7.5年的中位随访期间，17.4%的患者发生糖尿病（23.1/1000人-年，95% CI 21.3-25.1）。校正后，HR（hs-CRP第三个三分位数与第一个三分位数）为1.64（95% CI 1.26-2.13）。在单独的模型中，进一步调整BMI和腰围减弱了这种关联（HR分别为1.28 [95% CI 0.97-1.69]和1.35 [95% CI 1.03-1.78，趋势P < 0.05]）。在模型中加入HOMAIR后，这种关联不再显著。在校正HOMAIR分层分析中，HOMAIR <3.0的受试者与HOMAIR ≥ 3.0的受试者相比，hs-CRP-糖尿病相关性更强（相互作用P < 0.0001）。这种关联在非肥胖参与者中也更强，尽管在调整HOMAIR后并不显著。低度炎症，如测量hs-CRP水平，可能有一个重要的作用，在非洲裔美国人的糖尿病的发展与胰岛素抵抗程度较低。
Previous studies on the association between hs-CRP and incident type 2 diabetes among African Americans have been inconclusive. We examined the association between hs-CRP and incident diabetes in a large African American cohort (Jackson Heart Study). hs-CRP was measured in 3,340 participants. Incident diabetes was defined by fasting glucose ≥126 mg/dL, physician diagnosis, use of diabetes drugs, or A1C ≥6.5% (48 mmol/mol) at follow-up. Cox regression was used to estimate hazard ratios (HRs) for incident diabetes, adjusting for age, sex, education, diabetes family history, alcohol, HDL, triglycerides, hypertension status, hypertension medications, physical activity, BMI, HOMA-insulin resistance (HOMAIR), and waist circumference. Participants (63% women) were aged 53.3 ± 12.5 years. During a median follow-up of 7.5 years, 17.4% developed diabetes (23.1/1,000 person-years, 95% CI 21.3–25.1). After adjustment, the HR (hs-CRP third vs. first tertile) was 1.64 (95% CI 1.26–2.13). In separate models, further adjustment for BMI and waist circumference attenuated this association (HR 1.28 [95% CI 0.97–1.69] and 1.35 [95% CI 1.03–1.78, P < 0.05 for trend], respectively). Upon adding HOMAIR in the models, the association was no longer significant. In adjusted HOMAIR-stratified analysis, the hs-CRP–diabetes association appeared stronger in participants with HOMAIR <3.0 compared with HOMAIR ≥3.0 (P < 0.0001 for interaction). The association was also stronger among nonobese participants, although not significant when adjusted for HOMAIR. Low-grade inflammation, as measured by hs-CRP level, may have an important role in the development of diabetes among African Americans with a lesser degree of insulin resistance.