Why is diabetes mellitus a stronger risk factor for fatal ischemic heart disease in women than in men? The Rancho Bernardo Study

We report here the 14-year sex-specific effect of non-insulin-dependent diabetes mellitus on the risk of fatal ischemic heart disease in a geographically defined population of men and women aged 40 through 79 years. There were 207 men and 127 women who had diabetes at baseline based on medical history or fasting hyperglycemia. They were compared with 2137 adults who had fasting euglycemia and a negative personal and family history of diabetes. The relative hazard of ischemic heart disease death in diabetics vs nondiabetics was 1.8 in men and 3.3 in women, after adjusting for age, and 1.9 and 3.3, respectively, after adjusting for age, systolic blood pressure, cholesterol, body mass index, and cigarette smoking using the Cox regression model. The sex difference in the independent contribution of diabetes to fatal heart disease was largely explained by the persistently more favorable survival rate of women (than men) without diabetes.     

新疆乌鲁木齐市维吾尔族与汉族高血压病相关危险因素研究

目的探讨维吾尔族(维族)与汉族高血压病相关危险因素的异同。方法分别将10 638例维、汉族健康体检者分高血压组和非高血压组,对性别、年龄、吸烟史、饮酒史、高血压家族史、体质指数、腰围等相关危险因素分别进行单因素及多因素Logistic回归分析。结果汉族高血压组与非高血压组相比,年龄较大、高血压家族史、男性、腹型肥胖者的比例高(P均<0.05);维吾尔族高血压组与非高血压组相比,年龄较大、男性、肥胖比例高(P均<0.05)。经Logistic回归分析结果显示:年龄、腰围、体质指数、家族史与汉族高血压病独立相关;年龄、腰围、体质指数与维吾尔族高血压病独立相关。结论年龄、腹型肥胖、体质指数是维、汉族高血压病共同的危险因素。     

早期2型糖尿病相关高危因素的临床分析

目的探讨早期2型糖尿病相关高危因素,为临床预防及治疗提供理论依据。方法对553例2012年1¹2月南京市秦淮医院门诊患者进行空腹血浆葡萄糖或口服葡萄糖耐量试验筛查试验,按有无2型糖尿病分为糖尿病组和非糖尿病组,并记录年龄、性别、巨大儿、高血压病、高血压病家族史、高脂血症、冠心病、脑血管病、吸烟、饮酒、糖尿病家族史、肾病家族史、身高、体质量、血压、肌酐等临床参数,并计算体质量指数及肾小球滤过率。两组间比较采用t检验和χ2检验,危险因素采用Logistic回归分析。结果 Logistic回归分析显示高血压病家族史、饮酒和体质量指数是早期2型糖尿病发病的独立危险因素。结论存在高血压病家族史、饮酒和体质量指数偏高的患者应进行早期2型糖尿病筛查及随访。     

Association between smoking, pancreatic insulin secretion and insulin resistance in Chinese subjects with or without glucose intolerance

Background  There are studies suggesting smoking may increase the risk of type 2 diabetes. Effects of smoking on insulin secretion and insulin resistance (IR) are, however, controversial.
Methods  This is a cross-sectional study. Since there were very few smokers among Hong Kong Chinese women, only men (n=1068) were analyzed in this report. Fasting and 2-hour plasma glucose and insulin were measured. Insulinogenic index as well as beta-cell function and IR based on homeostatic model assessment (HOMA) by computer model (HOMA Calculator v2.2) were calculated.
Results  Of the 1068 men, 147 had newly diagnosed diabetes, 131 newly diagnosed impaired glucose tolerance (IGT) and 790 were non-diabetic normal controls. Smokers had similar fasting and 2-hour insulin levels, insulinogenic index and HOMA derived beta-cell function as compared to non-smokers in the groups with diabetes, IGT or normal oral glucose tolerance test (OGTT). IR was also similar between smokers, ex-smokers and non-smokers in those with normal OGTT. In men with IGT or diabetes, after adjustment for age and body mass index, smokers were more insulin resistant as compared to non-smokers (IR, IGT: 1.59±1.07 vs 1.03±0.54, P<0.05; diabetes: 1.96±1.36 vs 1.06±0.45, P<0.01). With Logistic regression analysis, comparing smokers and non-smokers, IR was independently associated with smoking (odds ratio (95% CI), IGT: 2.23 (1.05, 4.71); diabetes: 3.92 (1.22, 12.58)). None of the other insulin parameters enter into the model among those with normal OGTT or comparing ex-smokers and non-smoker or smokers and ex-smokers.
Conclusions  In Chinese men, smoking did not show any direct association with insulin levels and pancreatic insulin secretion. Smoking men with IGT or diabetes appeared more insulin resistant than their non-smoking counterparts.

     

心房利尿钠肽C-664G基因多态性与冠心病危险因素的分析

目的:探讨心房利尿钠肽(ANP)C-664G基因多态性与冠心病(CHD)危险因素的相关关系。方法:采用聚合酶链反应和限制型片断长度多态性(PCR-RFLP)的方法,分析158例CHD患者和165例非冠心病对照人群的C-664G(RsaI)基因多态性分布。结果:总研究人群中ANPC-664G的G和C两种等位基因分布频率为2.0%和98.0%。ANPC-664G基因型分布在两组人群中未发现显著性差异(P>0.05)。Logistic分析结果提示,男性、吸烟、高血压病史、糖尿病史、高血压家族史、血浆高胆固醇为冠心病的独立危险因素,但ANPC-664G型未能进入回归方程。且这种基因多态性分布与研究人群中的性别、体重指数、血脂、高血压病家族史、高血压病史、糖尿病家族史、糖尿病史、脑卒中家族史,脑卒中病史以及冠心病家族史之间并无显著关联(P>0.05)。结论:研究结果提示,ANPC-664G基因型与冠心病史并无显著相关性,可能不是冠心病的基因易感因素。     

吸烟、饮酒的糖尿病危险性分析

目的：了解吸烟、饮酒在糖尿病发病风险中的作用,及其对糖尿病及IGT患者餐后血糖、血压、BMI及WHR的影响。方法：利用广东省1998年对全省11742名抽样 群进行的糖尿病流行病学调查数据,做多元Logistic回归分析和广义线性模型方差分析。结果：调查人群中,糖尿病主要独立预测因素为年龄（OR＝2．053,1．568－2．687）、家族史（OR＝3．210,2．019－5．104）职业运动量（OR＝1．644,1．217－2．221）、WHR（OR＝2．255,1．690－3．008）、BMI（OR＝2．538,1．905－3．381）和高血压（OR＝3．088,2．246－4．245）。吸烟和饮酒的独立风险作风不显著,调整年龄,运动、家族史、经济水平等其他因素后,每日吸烟＞25支或每周饮酒7次的相对危险度（OR）分别为1．037（0．367－1．535）和1．261（0．718－2．214）。但吸烟、饮酒和年龄、职业反动量及家族史有明显的相乘交互作用,每日吸烟＞25支明显增加50岁以上人群和低职业运动量人群的糖尿病患者病险,每周饮酒＞7次除增加职业运动量较低人群患病风险外,使50岁以下人群的患病危险性增加1．42倍,并大幅增加糖尿病家族史人群的相对危险性（OR＝8．61,2．14－34．63）,在糖尿病及IGT患者中,当前吸烟者的BMI低于已戒烟和不吸烟者,WHR则高于不吸烟者,当前饮酒者BMI较已戒酒者低,但WHR差异不明显。结论：大量吸烟、饮酒是糖尿病可变的、非独立的危险因素,与年龄、少运动和家族史等主要危险因素有明显的相乘交互作用,吸烟可能导致糖尿病及IGT患者体脂异常分布。     

Prevalence of hypertension in patients with new onset type 2 diabetes mellitus

This study was conducted to find out the prevalence of hypertension in newly diagnosed patients with type 2 diabetes mellitus. Five hundred patients (229 men and 271 women) with type 2 diabetes mellitus diagnosed in the last 6 months were evaluated for hypertension and presence of various diabetes related complications. Overall 42% (210/500) of the patients had hypertension; more women (46.1%) than men (37.1%) were affected. Patients with hypertension were older, had higher body mass index and plasma triglyceride levels, and evidence of ventricular hypertrophy on electrocardiogram. Female sex, higher age, family history of hypertension or diabetes, history of neuropathic pains, higher body mass index, presence of albuminuria, dyslipidaemia or cardiac hypertrophy were found to affect prevalence of hypertension in newly diagnosed patients with type 2 diabetes mellitus.     

Association between diabetes and coronary heart disease in Aboriginal people: are women disadvantaged?

OBJECTIVES: To determine the incidence rate of coronary heart disease (CHD) in Australian Aboriginal people with type 2 diabetes, and to compare the impact of diabetes on CHD risk in Aboriginal women and men. DESIGN: Cohort study. SETTING: A remote Aboriginal community in the Northern Territory. PARTICIPANTS: 889 Aboriginal people aged 20-74 years followed up to 31 May 2003 after baseline examination in 1992-1995. MAIN OUTCOME MEASURES: Incidence rates of CHD (estimated for 123 participants with diabetes at baseline and 701 "non-diabetes" participants); rate ratios for diabetes risk (95% CI), with "non-diabetes" participants as the reference group. RESULTS: Participants with diabetes at baseline had a higher rate of CHD (37.5 per 1000 person-years) than those without diabetes (7.3 per 1000 person-years). Adjustment for multiple CHD risk factors, such as age, smoking, alcohol consumption, systolic blood pressure, body mass index, high-density lipoprotein cholesterol and total cholesterol levels, resulted in a CHD rate ratio for women of 3.7 (95% CI, 1.6-8.9) (comparing women with diabetes with those without) and a CHD rate ratio for men of 1.4 (95% CI, 0.4-4.1) (comparing men with diabetes with those without). CONCLUSIONS: Aboriginal women with diabetes experienced a significantly higher risk of CHD than women without diabetes. Although the difference was not statistically significant, women with diabetes had a higher CHD risk than men with diabetes.     

Important risk factors for death in adults: a 10-year follow-up of the Nutrition Canada survey cohort.

Data on mortality among over 8000 Canadians aged 35 to 79 years who participated in the Nutrition Canada survey are presented. The effects of various risk factors on mortality were assessed with a multivariate Poisson regression analysis. Factors associated with a significantly increased risk of death over a 10-year follow-up period ending in 1981 included cigarette smoking, hypertension and diabetes mellitus. A shallow U-shaped mortality pattern was observed for body mass index and for serum cholesterol level. No statistically significant increases in risk were associated with alcohol consumption. The population attributable risks for smoking, hypertension and diabetes were 39%, 8% and 6% respectively for men and 21%, 12% and 7% respectively for women.     

Body weight and risk of myocardial infarction and death in the adult population of eastern Finland

Body mass index (weight (kg) divided by height squared (m2] and its association with the risk of myocardial infarction and death from all causes were studied prospectively in a randomly selected population sample in eastern Finland aged 30-59 at outset in 1972. The study population consisted of 3786 men and 4120 women. The participation rate in the survey in 1972 was over 90%. All deaths and admissions to hospital in the sample were obtained from the National Death Certificate and Hospital Discharge Registers. During the seven years of follow up until 1978, 170 men and 52 women had acute myocardial infarction, and during the nine years up to 1980, 223 men and 92 women died. Independent of age, men with a body mass index of 28.5 or more had a significantly higher incidence of acute myocardial infarction. This effect was also independent of smoking but not independent of biological coronary risk factors--that is, serum cholesterol concentration and blood pressure. In the analysis stratified for smoking in men the body mass index total mortality curve was J shaped among non-smokers, whereas smoking entirely outweighed body mass index as a predictor of death. Body mass index did not contribute significantly to the risk of either acute myocardial infarction or death in women. It is concluded that a body mass index of around 29.0-31.0 or more is not only a marker for coronary risk factors but is also a predictor of acute myocardial infarction in men.     

扬中市40~70岁居民主要慢性病患病现状及影响因素分析

背景　慢性病（NCDs）危害居民身心健康的同时,还会给个人、家庭乃至社会带来巨大的疾病负担,是当下主要的公共卫生问题之一。目的　了解扬中市40~70岁居民主要NCDs（扬中市NCDs患病率顺位前5位的疾病）患病现状,分析其影响因素,为NCDs的防控提供理论依据。方法　2018年9月—2019年3月采取多阶段分层整群抽样的方法选取2 591例扬中市户籍居民作为调查对象,通过问卷调查、体格检查、内窥镜及病理学检查、实验室生化指标检测,了解主要NCDs患病现状,采用单因素Logistic回归分析及多因素Logistic回归分析探讨NCDs的影响因素。结果　NCDs患病率前5位分别为慢性胃炎（72.52%）、高血压（62.52%）、血脂异常（34.89%）、子宫肌瘤（12.50%）、糖尿病（10.61%）。男性高血压、胆囊炎/胆管炎、胆结石患病率低于女性,糖尿病、上消化道癌前病变、十二指肠溃疡、萎缩性胃炎患病率高于女性（P<0.05）。高血压、血脂异常、糖尿病患病率随年龄增加而增加,血脂异常患病率随年龄增加而降低,高血压患病率随着教育水平的增加而降低（P<0.05）。单因素Logistic回归分析结果显示,年龄、性别、受教育程度、家庭年收入、吸烟、被动吸烟、畜肉及其制品摄入情况、家禽及其制品摄入情况、蛋类及其制品摄入情况、水果摄入情况、奶制品摄入情况、NCDs家族史、心率过快、BMI与高血压的发生有关（P<0.05）,年龄、饮茶情况、家禽及其制品摄入情况、锻炼频率、体力劳动、NCDs家族史、BMI与血脂异常的发生有关（P<0.05）,年龄、性别、受教育程度、家庭年收入、吸烟、饮茶情况、锻炼频率、体力劳动、NCDs家族史、心率过快、BMI与糖尿病的发生有关（P<0.05）。多因素Logistic回归分析结果显示,年龄、吸烟、被动吸烟、奶制品摄入情况、NCDs家族史、心率过快、BMI是高血压的影响因素（P<0.05）;家禽及其制品摄入情况、NCDs家族史、BMI是血脂异常的影响因素（P<0.05）;年龄、性别、受教育程度、吸烟情况、锻炼频率、NCDs家族史、心率过快、BMI是糖尿病的影响因素（P<0.05）。结论　扬中市40~70岁居民主要NCDs防控形势严峻。男性高血压患病率低于女性,糖尿病患病率高于女性,应加强男性糖尿病及女性高血压的管理。肥胖或超重、NCDs家族史以及心率过快是多种NCDs的共有危险因素,应重点关注。     

社区糖尿病患者周围动脉病变的患病情况及危险因素

目的 了解社区2型糖尿病患者并发周围动脉病变 (PAD) 的患病率, 探讨其相关危险因素, 为社区有针对性地进行早期干预提供参考.方法 选取2014年6月至2015年6月深圳市某社区已确诊2型糖尿病患者662例, 根据踝肱动脉指数检测 (ABI<0.9) 分为并发PAD组和无PAD组, 统计患病率并采用单因素分析和多因素Logistic回归分析确定独立危险因素.结果 25.83% (171/662) 的糖尿病患者并发周围动脉病变.单因素分析结果表明年龄、受教育程度、糖尿病家族史、糖尿病病程、吸烟、运动、膳食习惯、荤素搭配、体质指数 (BMI) 、共患高血压、高血脂、结核病与PAD发病风险显著关联 (P<0.05) .多因素Logistic回归结果发现, 高龄、共患高血压、糖尿病病程久、血脂异常、BMI高、有糖尿病家族病史、吸烟是糖尿病患者并发PAD的独立危险因素 (P<0.05) .经常运动和高教育水平是抑制PAD发生发展的保护因素 (P<0.05) .结论 社区2型糖尿病人群中PAD患病率较高, 危险因素也较多.医务人员应充分重视并加强社区PAD的早期筛查及针对性地预防, 指导糖尿病患者在控制血糖的同时应严格控制其血压、调节血脂水平, 控制体质指数及倡导戒烟, 尤其对于高龄、病程较长、有糖尿病家族史的患者, 以有效降低PAD的患病率.     

年轻急性心肌梗死患者的临床特征

为探讨年轻患者急性心肌梗死 (AMI)的临床及冠状动脉特点 ,对 40岁以下男性 2 7例和绝经前女性 2 4例 ,共 5 1例急性心肌梗死 (AMI)患者的病史、动脉硬化相关危险因素、冠状动脉造影及预后进行分析。结果显示 ,女性组危险因素平均 2 .3个 ,按发生率高低分别为 :阳性家族史 1 9例 (79.2 % ) ,高胆固醇血症 1 2例 (5 0 .0 % ) ,高血压 1 0例 (4 1 .7% ) ,糖尿病 8例 (3 3 .3 % ) ,吸烟史 1例 (4 .2 % )。男性组危险因素平均 3 .1个 ,按发生率高低分别为 :吸烟史2 6例 (96.3 % ) ,高胆固醇血症 1 9例 (70 .4% ) ,阳性家族史 1 7例 (63 .0 % ) ,高血压 1 4例 (5 1 .9% ) ,糖尿病 7例(2 5 .9% )。冠状动脉造影结果显示 ,男性以单支病变为主 ,共 1 4例 ,占 5 1 .9% ,女性以多支病变为主 ,共 1 4例 ,占5 8.3 %。提示冠状动脉粥样硬化仍然是年轻男性和绝经前女性心肌梗死的主要原因 ,多个危险因素是年轻患者共同的特点 ,危险因素中女性以阳性家族史为首 ,男性则以吸烟史为首。     

Glucose tolerance abnormalities in Australian women with polycystic ovary syndrome

OBJECTIVES: To determine the prevalence of glucose tolerance abnormalities and to identify associated risk factors in women with polycystic ovary syndrome (PCOS) attending a reproductive endocrinology clinic. DESIGN: Retrospective chart review. PARTICIPANTS AND SETTING: 372 women with confirmed PCOS attending a reproductive endocrinology clinic at Adelaide University's Research Centre for Reproductive Health. MAIN OUTCOME MEASURES: Prevalence of glucose tolerance abnormalities and association of such abnormalities with potential risk factors. RESULTS: 4.0% (15 women) had diabetes mellitus, 15.6% (58) had impaired glucose tolerance and 80.4% (299) had normal glucose tolerance. There was a significant trend towards increasing prevalence of diabetes with increasing age (odds ratio [OR], 0.60; P = 0.0085). The prevalence of abnormal glucose tolerance (diabetes and impaired glucose tolerance together) was significantly higher with higher waist circumference (OR, 2.9; P = 0.05), higher body mass index (OR, 8.02; P = 0.0253), a family history of diabetes (OR, 1.56; P = 0.0192) and the presence of metabolic syndrome (OR, 5.62; P < 0.001). CONCLUSION: The prevalence of diabetes and impaired glucose tolerance is high in women with PCOS, especially in older women and those with abdominal obesity and a family history of diabetes.     

Prevalence of malnutrition and its risk factors in stroke patients residing in an infirmary

INTRODUCTION: The aim of this study was to investigate the prevalence of malnutrition, and its associated risk factors, in stroke patients residing in an infirmary in Hong Kong. METHODS: A cross-sectional retrospective study of 61 stroke patients residing in an infirmary was conducted. Baseline demographic data, including age, gender, smoking habit, and alcohol consumption, were obtained on admission. Nutritional status was assessed according to anthropometric parameters. Malnutrition was defined as having a body mass index (BMI) of below 18.5 kg per square metres for both gender and a serum albumin level of less than 35 g/L. 12 risk factors associated with malnutrition were evaluated according to established protocols. RESULTS: 61 of the 93 patients assessed had a history of cardiovascular accident and gave consent to participate in the study. Among them were 28 (46 percent) women and 33 (54 percent) men. The mean length of stay of these patients was 850 days (or 28 months). The mean age of these patients was 76 (standard deviation 12.8) years. Among the patients, five (8.2 percent) were malnourished and 56 (91.8 percent) were adequately nourished. There were no significant differences in the distribution of eight risk factors between the malnourished and nourished groups. These risk factors were a previous history of alcohol consumption, comorbidities (five or more), polypharmacy (five or more), diabetes mellitus, impaired functional status of daily living, impaired mobility (wheelchair- or bed-bound), tube-feeding, and edentulism. Insufficient data was available to assess the effects of two risk factors: depressed mood and impaired cognitive function. The distribution of another two risks factors (previous history of smoking and dysphagia) was significantly different between the malnourished and nourished groups. Odds ratios of smoking and dysphagia associated with malnourishment were approximately 3.3 and 2.6, respectively. CONCLUSION: Five of 61 (8.2 percent) stroke patients residing in an infirmary were malnourished. Two risk factors significantly associated with malnutrition were previous history of smoking and dysphagia. It is recommended that smoking history be elicited during routine history-taking of all stroke patients and particular nutritional attention be given to these at-risk patients. It is also emphasised that the management of dysphagia should follow a standardised protocol and form an integral element of patient care.     

Cigarette smoking and the risk of myocardial infarction, and acute non-infarct coronary events among Malaysian women

In a prospective case-control study over a two-year period involving 1006 women, 264 women with acute myocardial infarction (AMI), 305 with non-infarct acute coronary syndromes (CAD) were compared with 437 women with no coronary heart disease (Controls), to determine the relationship between cigarette smoking and other risks factors with coronary heart disease. A history of current cigarette smoking was strongly associated with the risk of coronary events for both AMI And CAD (p less than 0.001). 23.9% of patients with acute coronary syndromes were current smokers, compared with only 12.8% among controls. Overall, women smokers had about a two-fold increase in risk for all coronary events. Younger women smokers (less than 40 years) and those between 61-70 years had particularly higher risks (10.3 and 2.7 times respectively (p less than 0.01, p less than 0.02). A dose-response pattern of increased AMI risks (from 2.0 to 2.9 times) among women smokers was also found, corresponding to the number of cigarettes smoked per day (p less than 0.05). Other significant coronary risk factors established were: postmenopausal status (OR 6.5), diabetes mellitus (OR 5.1), hypertension (OR 1.6), family history of premature coronary heart disease less than 50 years (OR 1.3) and use of oral contraceptive pills (OR 1.4). Our results thus emphasize that cigarette smoking is an important determinant of acute coronary events even among Malaysian women.     

Smoking prevalence and associated risk factors in Canadian adults. Canadian Heart Health Surveys Research Group.

OBJECTIVE: To describe the prevalence and patterns of smoking among Canadian adults, the relation of smoking to other cardiovascular disease risk factors and the awareness of the causes of heart disease. DESIGN: Population-based cross-sectional surveys. SETTING: Nine Canadian provinces, from 1986 to 1990. PARTICIPANTS: A probability sample of 26,293 men and women aged 18 to 74 was selected from the health insurance registries in each province. Of these, 20,585 completed a questionnaire on smoking habits during a home interview. MAIN RESULTS: Approximately 29% of the Canadian population 18 years of age and over were regular cigarette smokers, and over 13% of regular smokers smoked more than 25 cigarettes per day. The proportion of women who had never smoked was higher (37%) than men (24%), except for young women aged 18 to 24. For all participants, there was a lower prevalence of high blood pressure and overweight among smokers than non-smokers. The prevalence of sedentary lifestyle, diabetes and elevated blood cholesterol was positively associated with smoking. The proportion of subjects who identified smoking as a cause of heart disease was higher among smokers, and over 90% believe that heart disease is preventable. CONCLUSION: Because smoking is positively associated with other cardiovascular risk factors, multifactorial and comprehensive approaches are needed in the implementation of cardiovascular disease prevention programs. Knowledge regarding the heart health hazards of smoking is high even among smokers. Motivational approaches that go beyond health risk messages are needed in cessation programs.     

2型糖尿病患者血尿酸水平与下肢血管病变的相关性

目的 分析2型糖尿病患者血尿酸(UA)水平与下肢血管病变的关系.方法 对2174例2型糖尿病患者(男1228例,女946例)进行体脂参数、血压、血糖、血脂、血UA、C反应蛋白(CRP)等测定,同时用高频超声检查下肢动脉,分析血UA水平与下肢血管病变发生率的相关性.结果 (1)将男女患者分别根据有无下肢血管病变分组,女性患者有下肢血管病变组的UA水平显著高于无下肢血管病变组[(304±76)μmol/L比(287±71)μmol/L,P<0.01],男性患者2组间差异无统计学意义[(332±76)μmol/L比(328±77)μmol/L,P=0.45].(2)将男女患者分别按血UA水平四分位间距分为4组,女性为UA<240 μmol/L组(A组),240 μmol/L≤UA<285μmol/L组(B组),285μmol/L≤UA<341 μmol/L组(C组),UA≥341 μmol/L组(D组).4组女性患者下肢血管病变发生率分别为38.56%,44.02%,47.54%和50.00%(趋势P<0.01).其中C组和D组的发生率均显著高于A组(P<0.05).(3)Logistic回归分析显示,在校正年龄、糖尿病病程、吸烟、收缩压、体质指数、总胆固醇、甘油三酯、CRP等因素后,以A组作为对照,女性2型糖尿病患者发生下肢血管病变的OR值B组为1.25(95%CI0.87～1.81;P=0.23),C组为1.44(95%CI1.01～2.08;P<0.05)和D组为1.59(95%CI 1.10～2.30;P=0.01),而男性差异无统计学意义.结论 血UA水平升高是女性2型糖尿病患者下肢血管病变的危险因素.     

Australian patterns of tobacco smoking in 1986

A total of 9440 Australian men and women of over 15 years of age was interviewed at home in 1986 to determine the prevalence and consumption levels of tobacco products. Current smokers were defined as those who smoked any combination of cigarettes, cigars or pipes regularly. The percentage of current smokers among men was 32.9% and among women was 28.5%, and the peak prevalence of smoking was in the age-group 20-24 years for both men (40.5%) and women (40.8%). Among men, 27.7% were past smokers, and among women, 16.5% were past smokers. The proportion of past smokers among those who had ever smoked was higher in men (0.46) than among women (0.37), but in the younger age groups there was no relative excess among men. Male smokers consumed more cigarettes per day than did female smokers and men were exposed to a higher daily average amount of cigarette tar. Sociodemographic variables that were associated with smoking in both men and women included age and educational and occupational level. Asian-born persons had a significantly lower prevalence of smoking than did persons who were born in Australia.     

Sex differences in osteoporosis in older adults with non-insulin-dependent diabetes mellitus.

OBJECTIVE--To describe the association of non-insulin-dependent diabetes mellitus (NIDDM) with bone mineral density (BMD). DESIGN--A survey of men and women from an established epidemiologic cohort who were separately screened for diabetes by oral glucose tolerance test between 1984 and 1987 and for osteopenia by BMD measured in 1988-1989. SETTING--A community-based population of older adults, Rancho Bernardo, Calif. PARTICIPANTS--The first 627 consecutively seen white men and women aged 55 to 88 years. MAIN OUTCOME MEASURES--Bone density measured by single photon absorptiometry at the ultradistal wrist and midradius and by dual x-ray absorptiometry at the femoral neck and lumbar spine. MAIN RESULTS--Among the 236 men and 391 women, whose average age was 72 years, 41 men and 39 women had NIDDM, 56 men and 110 women had impaired glucose tolerance, and 139 men and 242 women had normal glucose tolerance. Men with diabetes had BMD levels similar to those men with normal glucose tolerance, whereas women with diabetes had significantly higher BMD levels at all sites than women with normal glucose tolerance. The increased bone density in diabetic women was unexplained by age, obesity, cigarette smoking, alcohol intake, regular physical activity, and the use of diuretics and estrogen. The multiply adjusted mean BMD in women with NIDDM compared with normoglycemic women was 0.600 g/cm2 vs 0.548 g/cm2 at the midradius; 0.265 g/cm2 vs 0.230 g/cm2 at the ultradistal wrist; 0.654 g/cm2 vs 0.610 g/cm2 at the femoral neck; and 0.962 g/cm2 vs 0.859 g/cm2 at the spine. The sex differences were unexplained by survivor bias, prior obesity, or duration of diabetes. Differences were seen in women (but not men) whose diabetes was first detected at the screening evaluation, ie, before drug or dietary treatment. Similarly, in women (but not men) without diabetes increasing BMD levels at all four sites were associated with increasing postchallenge glucose levels independent of age and body mass index. CONCLUSIONS--Older women with NIDDM or hyperglycemia had better BMD than women with normal glucose tolerance, independent of differences in obesity and many other risk factors. No differences in bone density by diabetic status were observed in men. We hypothesize that the sex differences may be explained by the greater androgenicity reported in women with hyperglycemic and hyperinsulinemic conditions.