Plasma fatty acids and the risk of vascular disease and mortality outcomes in individuals with type 2 diabetes: results from the ADVANCE study
Plasma fatty acids and the risk of vascular disease and mortality outcomes in individuals with type 2 diabetes: results from the ADVANCE study
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DOI：
10.1007/s00125-020-05162-z
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发表时间：
2020-05-08
期刊：
影响因子：
8.2
通讯作者：
Woodward, Mark
中科院分区：
文献类型：
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作者：
Harris, Katie;Oshima, Megumi;Woodward, Mark
目的/假设本生物标志物研究旨在量化必需和其他血浆脂肪酸生物标志物与 2 型糖尿病患者大血管疾病、微血管疾病和死亡的关联。方法 作为糖尿病和血管疾病行动：Preterax 和 Diamicron 改良释放对照评估 (ADVANCE) 研究的二次分析（研究设计的全部细节和 ADVANCE 试验的主要终点及其病例队列之前已发布）。当前的研究考虑了新数据：通过质子核磁共振分析从基线血浆样本中测量脂肪酸。测量的脂肪酸为n-3、二十二碳六烯酸(DHA)、n-6、亚油酸以及多不饱和、单不饱和和饱和脂肪酸。 HR 是根据 SD 较高（百分比）脂肪酸建模的。采用C统计和连续净重分类改进来检验脂肪酸与传统心血管危险因素相比的附加价值。结果 调整传统心血管危险因素后，观察到 n-3 脂肪酸和 DHA 与大血管事件风险呈负相关（HR [95% CI]：每 1 SD 较高百分比分别为 0.87 [0.80, 0.95] 和 0.88 [0.81, 0.96]），n-3 脂肪酸与死亡风险呈负相关（HR 0.91 [95% CI 0.84， 0.99] 每 1 SD 更高的百分比）。在研究脂肪酸的绝对水平时，这种关联也很明显。调整后，任何脂肪酸与微血管疾病之间没有统计学上的显着关联。然而，当添加任何脂肪酸时，模型的预测能力的改善有限。结论/解释 血浆 n-3 脂肪酸和 DHA 被发现与大血管疾病呈负相关，而 n-3 脂肪酸也与死亡呈负相关。这些结果支持 n-3 脂肪酸和 DHA 的心脏保护作用，并值得进一步测试高剂量补充 n-3 脂肪酸对 2 型糖尿病患者的作用。
Aims/hypothesis This biomarker study aimed to quantify the association of essential and other plasma fatty acid biomarkers with macrovascular disease, microvascular disease and death in individuals with type 2 diabetes. Methods A case-cohort study (N = 3576), including 654 macrovascular events, 341 microvascular events and 631 deaths during 5 years of (median) follow-up, was undertaken as a secondary analysis of the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation (ADVANCE) study (full details of the study design and primary endpoints of the ADVANCE trial and its case-cohort have been published previously). This current study considers new data: fatty acids measured from baseline plasma samples by proton NMR analysis. The fatty acids measured were n-3, docosahexaenoic acid (DHA), n-6, linoleic acid, and polyunsaturated, monounsaturated and saturated fatty acids. HRs were modelled per SD higher (percentage) fatty acid. C statistics and continuous net reclassification improvement were used to test the added value of fatty acids compared with traditional cardiovascular risk factors. Results After adjustment for traditional cardiovascular risk factors, an inverse association was observed for n-3 fatty acids and DHA with the risk of macrovascular events (HR [95% CI]: 0.87 [0.80, 0.95] and 0.88 [0.81, 0.96], respectively, per 1 SD higher percentage), and for n-3 fatty acids with the risk of death (HR 0.91 [95% CI 0.84, 0.99] per 1 SD higher percentage). Such associations were also evident when investigating absolute levels of fatty acids. There were no statistically significant associations between any fatty acids and microvascular disease after adjustment. However, there was limited improvement in the predictive ability of models when any fatty acid was added. Conclusions/interpretation Plasma n-3 fatty acids and DHA were found to be inversely associated with macrovascular disease, while n-3 fatty acids were also inversely associated with death. These results support the cardioprotective effects of n-3 fatty acids and DHA and further merit testing the role of high-dose supplementation with n-3 fatty acids in individuals with type 2 diabetes.