Gout and the risk of type 2 diabetes among men with a high cardiovascular risk profile
Gout and the risk of type 2 diabetes among men with a high cardiovascular risk profile
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DOI：
10.1093/rheumatology/ken305
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发表时间：
2008-10-01
期刊：
影响因子：
5.5
通讯作者：
Krishnan, E.
中科院分区：
文献类型：
--
作者：
Choi, H. K.;De Vera, M. A.;Krishnan, E.
目标。我们的目的是评估痛风病史与心血管风险高的男性未来患2型糖尿病风险之间的独立关系。在6年的时间里，我们前瞻性地研究了来自多危险因素干预试验（MRFIT）的11351名男性参与者痛风与2型糖尿病发病风险之间的关系。偶发性糖尿病是根据美国糖尿病协会（ADA）流行病学研究标准定义的。采用Cox比例风险回归对潜在混杂因素进行校正。我们记录了1215例新的2型糖尿病病例。在调整了年龄、BMI、吸烟、2型糖尿病家族史、饮酒、饮食因素和代谢综合征的个体成分后，基线时痛风男性与无痛风男性发生2型糖尿病的多变量相对危险度（RR）为1.34 （95% CI 1.09, 1.64）。当我们进一步调整血清尿酸水平时，相关性仍然显著（RR 1.26; 95% CI 1.02, 1.54）。当我们在随访期间每年更新痛风的状态作为时变协变量时，相关性仍然相似。在主要协变量的亚组分析中，相关性也保持相似（相互作用的p值为0.16）。这些来自心血管疾病高风险人群的研究结果表明，痛风患者未来患2型糖尿病的风险较高，与其他已知风险因素无关。这些数据扩展了高尿酸血症、痛风和代谢综合征之间已建立的横断面关联，并扩展了与未来2型糖尿病风险的联系。
Objective. Our objective was to evaluate the independent relation between a history of gout and the future risk of type 2 diabetes among men with a high cardiovascular risk profile.Methods. We prospectively examined over a 6-yr period the relation between gout and the risk of incident type 2 diabetes in 11 351 male participants from the Multiple Risk Factor Intervention Trial (MRFIT). Incident diabetes was defined based on the American Diabetes Association (ADA) criteria for epidemiological studies. Cox proportional hazards regression was used to adjust for potential confounders.Results. We documented 1215 new cases of type 2 diabetes. After adjusting for age, BMI, smoking, family history of type 2 diabetes, alcohol intake, dietary factors and presence of individual components of the metabolic syndrome, the multivariate relative risk (RR) for incident type 2 diabetes among men with gout at baseline, as compared with men without gout, was 1.34 (95% CI 1.09, 1.64). When we further adjusted for serum uric acid levels, the association remained significant (RR 1.26; 95% CI 1.02, 1.54). When we updated the status of gout annually during follow-up as a time-varying covariate, the association remained similar. The association also remained similar in our subgroup analyses by major covariates (P-values for interaction >0.16).Conclusions. These findings from men with a high cardiovascular risk profile suggest that men with gout are at a higher future risk of type 2 diabetes independent of other known risk factors. These data expand on well-established, cross-sectional associations between hyperuricaemia, gout and the metabolic syndrome, and extend the link to the future risk of type 2 diabetes.