The association of ideal cardiovascular health with incident type 2 diabetes mellitus: the Multi-Ethnic Study of Atherosclerosis.
The association of ideal cardiovascular health with incident type 2 diabetes mellitus: the Multi-Ethnic Study of Atherosclerosis.
复制标题
DOI：
10.1007/s00125-016-4003-7
复制
发表时间：
2016-09
期刊：
影响因子：
8.2
通讯作者：
Golden SH
中科院分区：
文献类型：
--
作者：
Joseph JJ;Echouffo-Tcheugui JB;Carnethon MR;Bertoni AG;Shay CM;Ahmed HM;Blumenthal RS;Cushman M;Golden SH
理想的心血管健康水平（ICH）和2型糖尿病的发病率尚未在多种族人群中进行研究。我们根据美国心脏协会（AHA）ICH组分评估了糖尿病的总发病率和种族/种族特异性发病率。在2002年至2012年期间，对5，341名参与多种族动脉粥样硬化研究的参与者进行了糖尿病事件评估，这些参与者没有流行糖尿病。ICH组分（总胆固醇，BP，饮食摄入量，烟草使用，体力活动和BMI）在基线时进行评估，参与者被归类为具有理想，中等或不良心血管健康，如AHA 2020影响目标所定义的。我们根据ICH组分的数量（0-1“较差”，2-3“中等”和≥4“理想”）开发了一个评分系统。使用考克斯模型计算HR。在平均11.1年的随访中，我们发现了587例糖尿病病例。多变量校正后，有2-3个和≥4个ICH组分的受试者与0-1个组分的受试者相比，糖尿病发病率分别降低34%（HR 0.66; 95% CI 0.54，0.80）和75%（HR 0.25; 95% CI 0.18，0.35）。人种/种族之间存在显著差异：患有≥4种ICH组分的非洲裔美国人和西班牙裔美国人受试者的糖尿病发病率/1,000人-年分别为5.6（95% CI 3.1，10.1）和10.5（95% CI 6.7，16.4），而非西班牙裔白色美国人为2.2（95% CI 1.3，3.7）。满足越来越多的AHA 2020年饮食摄入量，体力活动，吸烟，BP，胆固醇和BMI的影响目标与剂量依赖性糖尿病风险降低相关，并因种族/民族而显着差异。
Levels of ideal cardiovascular health (ICH) and incident type 2 diabetes mellitus have not been examined in a multiethnic population. We assessed the total and race/ethnicity-specific incidence of diabetes based on American Heart Association (AHA) ICH components. Incident diabetes was assessed among 5,341 participants in the Multi-Ethnic Study of Atherosclerosis without prevalent diabetes between 2002 and 2012. ICH components (total cholesterol, BP, dietary intake, tobacco use, physical activity and BMI) were assessed at baseline and participants were categorised as having ideal, intermediate or poor cardiovascular health, as defined by the AHA 2020 impact goals. We developed a scoring system based on the number of ICH components (0–1 ‘poor’, 2–3 ‘intermediate’, and ≥4 ‘ideal’). HRs were calculated using Cox models. During a median follow-up of 11.1 years, we identified 587 cases of incident diabetes. After multivariable adjustment, participants with 2-3 and ≥4 ICH components vs 0-1 components had a 34% lower (HR 0.66; 95% CI 0.54, 0.80) and a 75% lower (HR 0.25; 95% CI 0.18, 0.35) diabetes incidence, respectively. There were significant differences by race/ethnicity: African-American and Hispanic-American participants with ≥4 ICH components had diabetes incidence rates per 1,000 person-years of 5.6 (95% CI 3.1, 10.1) and 10.5 (95% CI 6.7, 16.4), respectively, compared with 2.2 (95% CI 1.3, 3.7) among non-Hispanic white Americans. Meeting an increasing number of AHA 2020 impact goals for dietary intake, physical activity, smoking, BP, cholesterol and BMI was associated with a dose-dependent lower risk of diabetes with significant variation by race/ethnicity.