Von Willebrand Factor, Type 2 Diabetes Mellitus, and Risk of Cardiovascular Disease The Framingham Offspring Study
Von Willebrand Factor, Type 2 Diabetes Mellitus, and Risk of Cardiovascular Disease The Framingham Offspring Study
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DOI：
10.1161/circulationaha.108.792986
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发表时间：
2008-12-09
期刊：
影响因子：
37.8
通讯作者：
Tofler, Geoffrey H.
中科院分区：
文献类型：
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作者：
Frankel, David S.;Meigs, James B.;Tofler, Geoffrey H.
背景-血管性血友病因子（vWF）与心血管疾病（CVD）的相关性不一致。这可能是解释与2型糖尿病和insulinresistance.Methods和结果，我们测试了是否vWF预测事件CVD在3799 Fragrance后代研究参与者，特别是在那些与2型糖尿病或胰岛素抵抗的协会。在11年的随访中，351名参与者发生了CVD。比例风险模型（校正年龄、性别、血压、吸烟、体重指数、总胆固醇和高密度脂蛋白胆固醇，以及阿司匹林、胰岛素、抗高血压药和降脂药物治疗），以vWF分布的最低四分位数作为参考，CVD的风险比（HR）在第二四分位数为0.94，在第三四分位数为0.98，最高为1.32（趋势P = 0.04）。2型糖尿病或胰岛素抵抗（稳态模型）的额外调整部分减弱了相关性（多变量HR分别为1.28和1.21）。然后，我们根据糖尿病状态或胰岛素抵抗分布的稳态模型（上四分位数与下三个四分位数）对模型进行分层。在糖尿病患者中，vWF与CVD相关（相对于底部1.47，顶部四分位数的HR，趋势P = 0.04），但非糖尿病参与者中并非如此（HR 1.15，P = 0.5），在胰岛素抵抗患者中也是如此。（HR 1.50，P = 0.01）但不对胰岛素敏感（HR 1.02，P = 0.9）。结论：在2型糖尿病或胰岛素抵抗患者中，vWF水平升高与心血管疾病风险相关，这表明vWF可能是这些人群特有的危险因素。（循环。2008; 118：2533-2539）。
Background-Von Willebrand factor (vWF) is inconsistently associated with cardiovascular disease (CVD). This might be explained by associations of vWF with type 2 diabetes mellitus and insulin resistance.Methods and Results-We tested whether vWF predicted incident CVD in 3799 Framingham Offspring Study participants, and in particular, among those with type 2 diabetes mellitus or insulin resistance. During 11 years of follow-up, 351 participants developed CVD. In proportional hazards models (with adjustment for age, sex, blood pressure, smoking, body mass index, total and high-density lipoprotein cholesterol, and treatment with aspirin, insulin, antihypertensives, and lipid-lowering medications) with the lowest quartile of the vWF distribution as the referent, the hazard ratio (HR) for CVD was 0.94 in the second quartile, 0.98 in the third, and 1.32 in the highest (P = 0.04 for trend). Additional adjustment for type 2 diabetes mellitus or insulin resistance (homeostasis model) partially attenuated the association (multivariable HRs for top quartile 1.28 and 1.21, respectively). We then stratified the models by diabetes status or the homeostasis model of insulin resistance distribution (top quartile versus lower 3 quartiles). vWF was associated with CVD among participants with diabetes mellitus (HR for top quartile relative to bottom 1.47, P = 0.04 for trend) but not among nondiabetic participants (HR 1.15, P = 0.5) and similarly among insulin-resistant (HR 1.50, P = 0.01) but not insulin-sensitive (HR 1.02, P = 0.9) participants.Conclusions-Higher levels of vWF were associated with risk of CVD in people with type 2 diabetes mellitus or insulin resistance, which suggests that vWF may be a risk factor unique to these populations. (Circulation. 2008; 118: 2533-2539.)