Age, gender, insulin and blood glucose control status alter the risk of ischemic heart disease and stroke among elderly diabetic patients.
Age, gender, insulin and blood glucose control status alter the risk of ischemic heart disease and stroke among elderly diabetic patients.
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DOI：
10.1186/1475-2840-10-86
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发表时间：
2011-10-06
影响因子：
9.3
通讯作者：
Japan Cholesterol and Diabetes Mellitus Investigation Group
中科院分区：
文献类型：
--
作者：
Hayashi T;Kawashima S;Nomura H;Itoh H;Watanabe H;Ohrui T;Yokote K;Sone H;Hattori Y;Yoshizumi M;Ina K;Kubota K;Japan Cholesterol and Diabetes Mellitus Investigation Group
根据血糖控制情况，分析胰岛素治疗、年龄和性别对缺血性心脏病（IHD）和脑血管意外（CVA）发生风险的影响。我们对2型糖尿病患者（n = 4014）进行了为期2年的前瞻性队列研究（日本胆固醇和糖尿病研究）。主要终点是致死性/非致死性IHD和/或CVA的发生率，分别为每1000人年7.9和7.2例。我们将糖尿病患者根据年龄（≤70岁和bbb70岁）和血红蛋白A1C水平（≤7.0岁和bbb70岁）分为四组。多元回归分析显示，在70岁以下血糖控制良好的患者中，IHD与高收缩压和低HDL-C相关，而在老年/良好组中，IHD与低舒张压相关。有趣的是，胰岛素使用与老年/贫困组的IHD相关（OR = 2.27, 95% CI = 1.11-5.89; p = 0.026），与老年/贫困组的CVA相关（OR = 2.09, 95% CI = 1.06-4.25; p = 0.028）。在年轻/血糖控制不良的组中，CVA与较低的HDL-C和较长的糖尿病持续时间有关。逐步分析结果相似。接下来，根据性别和糖尿病控制情况（血红蛋白a1c <或≤7.0%）将患者分为四组。多元回归分析显示，男性/血糖对照组患者收缩压高，男性/血糖对照组患者年龄大，两组患者女性糖尿病史短均与IHD相关。有趣的是，胰岛素使用与男性/贫困组的IHD相关（OR = 4.11, 95% CI = 1.22-8.12; p = 0.018），与女性/贫困组的CVA相关（OR = 3.26, 95% CI = 1.12-6.24; p = 0.02）。在两组女性患者中，CVA与糖尿病持续时间较短有关。糖尿病患者的IHD和CVA风险受到治疗、性别和年龄等特定因素的影响。具体而言，胰岛素使用在预防IHD方面具有潜在作用，但也可能是老年糖尿病患者CVA的危险因素，因此需要开发改进的老年糖尿病患者治疗策略。制定了日本胆固醇和糖尿病研究来评估它们（Umin临床试验注册，临床试验注册）。否。UMIN00000516;http://www.umin.ac.jp/ctr/index.htm)。
We analyzed the effects of insulin therapy, age and gender on the risk of ischemic heart disease (IHD) and cerebrovascular accident (CVA) according to glycemic control. We performed a prospective cohort study (Japan Cholesterol and Diabetes Mellitus Study) of type 2 diabetes patients (n = 4014) for 2 years. The primary endpoint was the onset of fatal/non-fatal IHD and/or CVA, which occurred at rates of 7.9 and 7.2 per 1000 person-years, respectively. We divided diabetic patients into four groups based on age (≤ 70 and > 70) and hemoglobin A1C levels (≤ 7.0 and > 7.0%). Multiple regression analysis revealed that IHD was associated with high systolic blood pressure and low HDL-C in patients under 70 years of age with fair glycemic control and was associated with low diastolic blood pressure in the older/fair group. Interestingly, insulin use was associated with IHD in the older/poor group (OR = 2.27, 95% CI = 1.11-5.89; p = 0.026) and was associated with CVA in the older/fair group (OR = 2.09, 95% CI = 1.06-4.25; p = 0.028). CVA was associated with lower HDL-C and longer duration of diabetes in younger/poor glycemic control group. Results by stepwise analysis were similar. Next, patients were divided into four groups based on gender and diabetic control(hemoglobinA1C < or > 7.0%). Multiple regression analysis revealed that IHD was associated with high systolic blood pressure in male/fair glycemic control group, age in male/poor control group, and short duration of diabetic history in females in both glycemic control groups. Interestingly, insulin use was associated with IHD in the male/poor group(OR = 4.11, 95% CI = 1.22-8.12; p = 0.018) and with CVA in the female/poor group(OR = 3.26, 95% CI = 1.12-6.24; p = 0.02). CVA was associated with short duration of diabetes in both female groups. IHD and CVA risks are affected by specific factors in diabetics, such as treatment, gender and age. Specifically, insulin use has a potential role in preventing IHD but may also be a risk factor for CVA among the diabetic elderly, thus revealing a need to develop improved treatment strategies for diabetes in elderly patients. The Japan Cholesterol and Diabetes Mellitus Study was formulated to evaluate them(Umin Clinical Trials Registry, clinical trial reg. no. UMIN00000516; http://www.umin.ac.jp/ctr/index.htm).
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影响因子：
168.9
作者：
Turner, RC;Holman, RR;Ward, JD
通讯作者：
Ward, JD
影响因子：
16.2
作者：
Stevens, R;Coleman, RL;Holman, RR
通讯作者：
Holman, RR
DOI：
10.1034/j.1600-0579.2003.00211.x
发表时间：
2003-05-01
影响因子：
6.3
作者：
Brown, AF;Gross, AG;Mangione, CM
通讯作者：
Mangione, CM
影响因子：
158.5
作者：
Duckworth, William;Abraira, Carlos;Huang, Grant D.
通讯作者：
Huang, Grant D.
影响因子：
9.9
作者：
Milionis, H. J.;Giannopoulos, S.;Vemmos, K.
通讯作者：
Vemmos, K.