Nonalcoholic fatty liver disease and risk of future cardiovascular events among type 2 diabetic patients
Nonalcoholic fatty liver disease and risk of future cardiovascular events among type 2 diabetic patients
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DOI：
10.2337/diabetes.54.12.3541
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发表时间：
2005-12-01
期刊：
影响因子：
7.7
通讯作者：
Falezzal, G
中科院分区：
文献类型：
--
作者：
Targher, G;Bertolini, L;Falezzal, G
非酒精性脂肪性肝病（NAFLD）与多种代谢综合征特征密切相关。我们前瞻性地评估了在2型糖尿病患者中，NAFLD是否能预测未来心血管疾病（CVD）事件，且独立于代谢综合征特征及其他传统危险因素。我们在2103名基线时无确诊心血管疾病的2型糖尿病患者中进行了一项前瞻性巢式病例对照研究。在5年的随访期间，248名参与者（病例组）随后发生了非致命性冠心病（心肌梗死和冠状动脉血运重建术）、缺血性脑卒中或心血管死亡。采用风险集抽样，在随访期间未发生确诊心血管疾病的患者中，按2∶1的比例随机选取496名患者（对照组），使其在年龄和性别上与病例组匹配。在对年龄、性别、吸烟史、糖尿病病程、糖化血红蛋白（HbA₁c）、低密度脂蛋白胆固醇、肝酶以及药物使用情况进行调整后，NAFLD的存在与心血管疾病风险增加显著相关（比值比1.84，95%置信区间1.4 - 2.1，P < 0.001）。对代谢综合征（按照美国国家胆固醇教育计划成人治疗小组III标准定义）进一步调整后，这种相关性明显减弱，但并未消失（1.53，1.1 - 1.7，P = 0.02）。总之，在2型糖尿病患者中，NAFLD与心血管疾病风险适度增加显著相关。这种关系独立于传统危险因素，且代谢综合征的发生只能部分解释这种关系。
Nonalcoholic fatty liver disease (NAFLD) is closely correlated to several metabolic syndrome features. We assessed prospectively whether NAFLD predicts future cardiovascular disease (CVD) events among type 2 diabetic individuals, independent of metabolic syndrome features and other classical risk factors. We carried out a prospective nested case-control study in 2,103 type 2 diabetic patients who were free of diagnosed CVD at baseline. During 5 years of follow-up, 248 participants (case subjects) subsequently developed nonfatal coronary heart disease (myocardial infarction and coronary revascularization procedures), ischemic stroke, or cardiovascular death. Using risk-set sampling, 496 patients (control subjects) among those who remained free of diagnosed CVD during follow-up were randomly selected in a 2:1 ratio, matched for age and sex to the case subjects. After adjustment for age, sex, smoking history, diabetes duration, HbA(1c), LDL cholesterol, liver enzymes, and use of medications, the presence of NAFLD was significantly associated with an increased CVD risk (odds ratio 1.84, 95% Cl 1.4-2.1, P < 0.001). Additional adjustment for the metabolic syndrome (as defined by National Cholesterol Education Program Adult Treatment Panel III criteria) appreciably attenuated, but did not abolish, this association (1.53, 1.1-1.7, P = 0.02). In conclusion, NAFLD is significantly associated with a moderately increased CVD risk among type 2 diabetic individuals. This relationship is independent of classical risk factors and is only partly explained by occurrence of metabolic syndrome.