Coronary artery disease in IDDM - Gender differences in risk factors but not risk
Coronary artery disease in IDDM - Gender differences in risk factors but not risk
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DOI：
10.1161/01.atv.16.6.720
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发表时间：
1996-06-01
影响因子：
8.7
通讯作者：
Orchard, TJ
中科院分区：
文献类型：
--
作者：
Lloyd, CE;Kuller, LH;Orchard, TJ
与普通人群相比，胰岛素依赖型糖尿病（IDDM）增加了患冠状动脉疾病（CAD）的风险，而在IDDM人群中CAD发病率的性别差异显著降低。为了进一步理解这些观察结果，我们研究了性别对冠心病发病率基线危险因素的影响。匹兹堡糖尿病并发症流行病学（EDC）研究的参与者是从匹兹堡儿童医院的IDDM登记处招募的，并在1950年至1980年之间被诊断。受试者完成了一系列问卷调查，并在基线（1986年至1988年）和随后每两年进行一次全面的临床检查。本报告基于前4年的随访。在男性和女性中观察到新发CAD事件的发生率相似。在两种性别中，血糖控制都不是晚期CAD的预测因素。性别特异性考克斯比例风险模型显示，对于男性，胰岛素依赖型糖尿病病程、高密度脂蛋白胆固醇、纤维蛋白原、高血压和吸烟均与CAD的发病显著相关。高血压、纤维蛋白原和吸烟都被肾病取代，当后一个变量加入模型中时。对于女性，病程、高血压、腰臀比、体力活动和抑郁性精神病都是CAD的重要独立预测因素。肾病状态未进入女性模型。虽然在这一人群中，IDDM患者的4年CAD发病率变化不大，但预测风险因素变化很大。特别是，肾脏疾病的影响在男性中更强，而体力活动、腰臀比和抑郁症在女性中更重要。这些结果可能有助于解释相对较大的影响，胰岛素依赖型糖尿病对妇女的冠心病风险，并提出新的潜在的预防方法。
Insulin-dependent diabetes mellitus (IDDM) increases the risk of developing coronary artery disease (CAD) compared with that seen in the general population, while the sex differential in rates of CAD is considerably reduced in IDDM populations. To further our understanding of these observations, the effects of gender on baseline risk factors for CAD incidence were examined. Participants in the Pittsburgh Epidemiology of Diabetes Complications (EDC) Study were recruited from the Children's Hospital of Pittsburgh IDDM registry and had been diagnosed between 1950 and 1980. Subjects completed a series of questionnaires and were given a full clinical examination at baseline (1986 through 1988) and every subsequent 2 years. This report is based on the first 4 years of follow-up. Similar incidence rates of new CAD events were observed in men and women. In neither sex was glycemic control a predictor of later CAD. Sex-specific Cox proportional hazards models showed that for men, duration of IDDM, HDL cholesterol, fibrinogen, hypertension, and smoking were all significantly associated with the onset of CAD. Hypertension, fibrinogen and smoking were all replaced by nephropathy when this latter variable was added to the model. For women, duration, hypertension, waist-hip ratio, physical activity: and depressive symptomatology were all significant independent predictors of CAD. Nephropathy status did not enter the model for women. While 4-year incidence of CAD in IDDM varies little by seu in this population, the predictive risk factors vary considerably. In particular, the effect of renal disease was stronger in men, while the cluster of physical activity, waist-to-hip ratio, and depressive symptomatology were more Important in women. These results may help explain the relatively greater impact IDDM has on CAD risk for women and suggest new potential preventive approaches.