Incidence of and risk factors for asymptomatic peripheral arterial occlusive disease: a longitudinal study

The current study describes the age- and sex-specific incidence rates and risk factors for asymptomatic and symptomatic peripheral arterial occlusive disease (PAOD) among 2,327 subjects and the incidence of intermittent claudication in asymptomatic PAOD subjects. The study population was selected from 18 general practice centers in the Netherlands. PAOD was assessed with the ankle-brachial blood pressure index, and intermittent claudication was assessed with a modified version of the Rose questionnaire. After 7.2 years, the overall incidence rate for asymptomatic PAOD, using the person-years method, was 9.9 (95% confidence interval (CI): 7.3, 18.8) per 1,000 person-years at risk. The rate was 7.8 (95% CI: 4.9, 20.3) for men and 12.4 (95% CI: 7.7, 24.8) for women. For symptomatic PAOD, the incidence rate was 1.0 (95% CI: 0.7, 7.5) overall, 0.4 (95% CI: 0.3, 10.0) for men, and 1.8 (95% CI: 1.0, 10.3) for women. Multivariate analyses showed that increasing age, smoking, hypertension, and diabetes mellitus were the most important risk factors. The overall incidence rate for intermittent claudication among PAOD subjects who were asymptomatic at baseline was 90.5 per 1,000 person-years at risk (95% CI: 36.4, 378.3). The incidence of asymptomatic PAOD was higher than the incidence of symptomatic PAOD, with women developing PAOD more often than men. In the development of preventive strategies, modification of atherosclerotic risk factors, such as smoking, hypertension, and diabetes, should be the main goals.     

Risk of type 2 diabetes among HIV-infected and healthy subjects in Italy

Type 2 diabetes mellitus is a growing problem in HIV population and a comparison with the general population may help screening and prevention. In this cross-sectional study the authors determined the prevalence of type 2 diabetes mellitus in 4,249 HIV-infected subjects attending the San Raffaele Infectious Diseases Department compared with 9,148 healthy controls recruited in 15 Italian regions, and identified risk factors associated with of type 2 diabetes mellitus. Type 2 diabetes mellitus was defined as reported diabetes, a fasting plasma glucose concentration ≥7.0?mmol/l, or current use of anti-diabetic medication. Prevalence of type 2 diabetes mellitus was higher in HIV-infected than healthy subjects (4.1 vs. 2.5?%; P?相似文献   

北京市某社区中老年人群肾功能下降与心血管事件的关联研究

目的 了解肾功能下降与心血管事件是否有独立的关联关系.方法 2004年在北京市首钢社区随机抽取40岁及以上人群2500人,实际调查2315人.收集清晨首次尿标本,测量尿白蛋白和肌酐;采静脉血标本,测量血肌酐;使用简化的MDRD公式估计肾小球滤过率(eGFR),同时调查心血管病危险因素.随后对上述调查人群随访4年,记录心血管事件.根据eGFR值[ml/(min·1.73m2)]将人群分为3组,＜60、60～90、＞90.使用Cox回归模型调整混杂因素,分析慢性肾脏病与心血管事件及总事件的关联.结果 2315人中,肾功能下降(eGFR＜60)的患病率为3.3%.三组人群心血管事件发生率分别为43.9/1000人年、21.8/1000人年和11.5/1000人年,总事件发生率分别为53.7/1000人年、28.8/1000人年和14.6/1000人年.调整混杂因素后,与eGFR＞90组相比,60≤eGFR＜90组和eGFR＜60组心血管事件发生的风险(95%CI)分别为1.29(0.85～1.96)和2.14(1.02～4.50);总事件发生的风险分别为1.25(0.86～1.81)和1.95(1.00～3.80).结论 肾功能下降与心血管事件及总事件独立相关.     

Cardiovascular risk profile of type 2 diabetic patients cared for by general practitioners or at a diabetes clinic: a population-based study.

The aims of this study were to compare the cardiovascular risk profiles of patients with type 2 diabetes mellitus cared for by general practitioners and those regularly attending a diabetes center. Out of an Italian population-based cohort of 1967 diabetic patients, 1574 (80%) were investigated. Patients exclusively cared for by general practitioners (23.8%) were older and showed lower prevalence of hypertension (79.0% vs 85.9%, P < 0.001), poor blood glucose control (HbA1c >8.0, 33.4% vs 47.9%, P < 0.001) and coronary heart disease (18.1% vs 22.3%, P = 0.003), and lower plasma fibrinogen (3.5 +/- 0.8 vs 3.7 +/- 0.9 g/L, P < 0.001). In logistic regression analysis, they had significantly lower ORs for HbA1c >8.8% (OR 0.67, 95% CI 0.45-0.99), hypertension (OR 0.53, 95% CI 0.36-0.78), fibrinogen >4.1 g/L (OR 0.50, 95% CI 0.32-0.77), smoking (OR 0.60, 95% Cl 0.36-1.00), and coronary heart disease (OR 0.65, 95% CI 0.45-0.93), after adjustment for age, sex, duration of diabetes, BMI, and antidiabetic treatment. Patients regularly cared for at a diabetes clinic had a higher cardiovascular risk profile, suggesting selective referral to the clinics of patients with more difficult management and/or severity of the disease. These findings have implications in the interpretation of morbidity and mortality clinic-based studies.     

德清农村居民糖尿病和高血压共患病率及其危险因素

  目的  了解德清农村居民糖尿病和高血压共患病情况并探究其危险因素。  方法  采用横断面研究，在浙江省德清县随机整群抽取8个乡镇作为研究现场，共调查29 306名成人居民。调查内容包括:人口学信息、社会经济学特征、行为和生活方式、慢性病家族史，进行血压、血糖的测量。  结果  在研究人群中，2型糖尿病患病率为3.34%，高血压患病率为28.72%，其中2.01%人群共患糖尿病和高血压，共患率在70~79岁均达到较高水平。无序多元Logistics回归结果显示:糖尿病家族史(OR=4.94，95%CI:3.24~7.54，P < 0.001)、拥有伴侣(OR=2.17，95%CI:1.18~4.00，P=0.013)是仅糖尿病患病的可能危险因素，体重指数(body mass index，BMI) < 24 kg/m2(OR=0.48，95%CI:0.39~0.59，P < 0.001)是糖尿病的可能保护因素；BMI < 24 kg/m2(OR=0.60，95%CI:0.56~0.64，P < 0.001)、完成义务教育(OR=0.54，95%CI:0.49~0.59，P < 0.001)、运动(OR=0.77，95%CI:0.69~0.86，P < 0.001)是高血压患病的保护因素，饮酒(OR=1.18，95%CI:1.08~1.29，P < 0.001)是仅高血压患病的可能危险因素；BMI < 24 kg/m2(OR=0.26，95%CI:0.21~0.31，P < 0.001)、完成义务教育(OR=0.50，95%CI:0.35~0.72，P < 0.001)、饮茶(OR=0.80，95%CI:0.64~0.99，P=0.045)是两病共患的保护因素，农民(OR=1.35，95%CI:1.04~1.76，P=0.024)、糖尿病家族史(OR=4.21，95%CI:2.71~6.57，P < 0.001)、高血压家族史(OR=1.86，95%CI:1.31~2.64，P=0.001)是两病共患的危险因素。  结论  德清地区农村居民糖尿病患病水平低于全国平均水平，高血压患病水平与全国平均水平接近，也有一定的共患病水平。女性、年龄>60岁、农民、糖尿病家族史、高血压家族史、超重或肥胖人群是可能的高危因素，需要进一步的干预和控制。     

Waist circumference as a measurement of obesity in the Netherlands Antilles; associations with hypertension and diabetes mellitus

OBJECTIVES: To evaluate waist circumference (WC) as a screening tool for obesity in a Caribbean population. To identify risk groups with a high prevalence of (central) obesity in a Caribbean population, and to evaluate associations between (central) obesity and self-reported hypertension and diabetes mellitus. DESIGN: Cross-sectional. SETTING: Population-based study. SUBJECTS: A random sample of adults (18 y or older) was selected from the Population Registries of three islands of the Netherlands Antilles. Response was over 80%. Complete data were available for 2025 subjects. INTERVENTION: A questionnaire and measurements of weight, height, waist and hip. MAIN OUTCOME MEASUREMENT: Central obesity indicator (WC > or =102 cm men, > or =88 cm women). RESULTS: WC was positively associated with age (65-74 y vs 18-24 y) in men (OR=7.7, 95% CI 3.4-17.4) and women (OR=6.4, 95% CI 3.2-12.7). Women with a low education had a higher prevalence of central obesity than women with a high education (OR=0.5, 95% CI 0.3-0.7). However, men with a high income had a higher prevalence of a central obesity than men with a low income (OR=1.7, 95% CI=1.1-2.6). WC was the strongest independent obesity indicator associated with self-reported hypertension (OR=1.7, 95% CI 1.4-2.0) and diabetes mellitus (OR=1.6, 95% CI 1.3-1.9). CONCLUSIONS: The identified risk groups were women aged 55-74 y, women with a low educational level and men with a high income. WC appears to be the major obesity indicator associated with hypertension and diabetes mellitus. SPONSORSHIP: Island Governments of Saba, St Eustatius and Bonaire, the Federal Government of the Netherlands Antilles, Dutch Directorate for Kingdom relationships.     

High blood pressure and the incidence of non-insulin dependent diabetes mellitus: Findings in A 11.5 year follow-up study in the Netherlands

To examine the contribution of cardiovascular risk factors to the development of non-insulin dependent diabetes mellitus, a prospective follow-up study was performed of a cohort, initially examined in a population survey on cardiovascular risk factors. The survey was conducted from 1975 to 1978 in the Netherlands among 5700 men and women aged 20 to 65. In 1988 a questionnaire on the prevalence of chronic diseases, including diabetes mellitus, was sent to all living participants of the initial survey. The general practitioners of the persons who indicated to have diabetes mellitus were asked to confirm the diagnosis. Diabetes mellitus was defined as current use of oral hypoglycemic drugs or insulin. After exclusion of the prevalent cases at the initial survey, 65 incident confirmed cases remained. All others responding to the questionnaire served as controls.The incidence of diabetes mellitus was associated with body mass index, use of diuretics, systolic and diastolic blood pressure. After adjustment for age and body mass index systolic and diastolic blood pressure were still associated with the incidence of non-insulin dependent diabetes mellitus in men; relative risks 1.28 (95% confidence interval 1.06–1.54) and 1.40 (95% CI 1.06–1.85) per 10 mmHg respectively. For women, only the relative risk associated with the use of diuretics remained statistically significant (2.26, 95% CI 1.04–4.90). This probably reflects the risk of (treated) hypertension: adjusted for blood pressure, the relative risk lost statistical significance.These findings suggest that elevated blood pressure is a risk for the development of non-insulin dependent diabetes mellitus (NIDDM). This supports the view that NIDDM and hypertension may have a similar origin.     

Tobacco use and cardiovascular disease among American Indians: the strong heart study

Tobacco use among American Indians has a long and complicated history ranging from its utilization in spiritual ceremonies to its importance as an economic factor for survival. Despite this cultural tradition and long history, there are few studies of the health effects of tobacco in this population. The Strong Heart Study is a prospective observational study of cardiovascular disease (CVD) in 13 American Indian tribes in Arizona, Oklahoma, and North and South Dakota with 4,549 participants. Baseline examinations were followed by two examinations at regular intervals and 16 years of morbidity and mortality follow-up. Hazard ratios (HRs) for non-fatal CVD for current smokers vs. non-smokers after adjusting for other risk factors were significant in women (HR = 1.94, 95% CI 1.54 to 2.45) and men (HR = 1.59, 95% CI 1.16 to 2.18). Hazard ratios for fatal CVD for current smokers vs. non-smokers after adjusting for other risk factors were significant in women (HR = 1.64, 95% CI 1.04 to 2.58), but not in men. Individuals who smoked and who were diagnosed with diabetes mellitus, hypertension or renal insufficiency were more likely to quit smoking than those without these conditions. On average, American Indians smoke fewer cigarettes per day than other racial/ethnic groups; nevertheless, the ill effects of habitual tobacco use are evident in this population.     

Incidence and Predictors of Hypertension Among Rural Chinese Adults: Results From Liaoning Province

OBJECTIVE We wanted to determine the incidence of hypertension and its risk factors among rural Chinese adults.METHODS A population-based sample of 24,360 rural Chinese adults aged 35 years and older and free from hypertension at baseline was observed from 2004–2006 to 2008. Incident hypertension was defined as a systolic pressure of 140 mm Hg or greater, diastolic pressure of 90 mm Hg or greater, or current use of antihypertensive medication.RESULTS During a mean follow-up period of 28 months, 29.6% of men and 23.4% of women developed hypertension. The age-adjusted incidence was higher in men (12.75 per 100 person-years) than in women (10.04 per 100 person-years). Among men, independent predictors of incident hypertension were baseline age (hazard ratio [HR] = 1.11; 95% confidence interval [CI], 1.10–1.13), Mongolian ethnicity (HR = 1.09; 95% CI, 1.01–1.18), use of alcohol, (HR = 1.14; 95% CI, 1.06–1.23), high income vs low income (HR = 1.11; 95% CI, 1.00–1.22; and HR = 1.11; 95% CI, 1.03–1.20), prehypertension vs normotension (HR = 1.18; 95% CI, 1.08–1.28), overweight and obesity (HR = 1.28; 95% CI, 1.17–1.40), baseline salt intake (HR = 1.00; 95% CI, 1.00–1.01) and family history of hypertension (HR = 1.14; 95% CI, 1.03–1.27). With the exception of use of alcohol and mean income, the results were similar for women, except that low physical activity was shown as a risk factors as well. The awareness, treatment, and control rates for newly developed hypertension were 29.9%, 19.5%, and 1.5%, respectively.CONCLUSIONS These data indicate that the incidence of hypertension is high among these rural Chinese adults and that it is associated with many risk factors. Our findings further suggest that most newly developed hypertension cases are not treated. The increases in hypertension are probably related to rapid social changes in our country and may apply to other areas of the developing world. These findings call for urgent improvements in hypertension prevention and control programs in rural China.     

Management of Hypertension in Patients with Diabetes Mellitus

Hypertension and diabetes mellitus are significant and independent risk factors for cardiovascular disease.Antihypertensive therapy reduces cerebrovascular and cardiovascular morbidity and mortality in patients with hypertension. Tight blood pressure (BP) control [target diastolic BP (DBP) ≤80mm Hg] reduced the incidence of major cardiovascular events by 51% compared with less tight control (DBP ≤90mm Hg) in patients with diabetes mellitus in the Hypertension Optimal Treatment (HOT) study. Similarly, in the UK Prospective Diabetes Study (UKPDS), tight BP control [mean systolic BP (SBP)/DBP = 144/82mm Hg] with captopril or atenolol reduced diabetes mellitus-related morbidity and mortality by 24% compared with less tight control (mean SBP/DBP = 154/87mm Hg). Importantly, the frequency of microvascular disease (including retinopathy) was reduced by 37% among those randomised to tight BP control in the UKPDS.In the diabetic subgroup in the Heart Outcomes Prevention Evaluation (HOPE) study, there was a 25% reduction in the composite end-point of death due to cardiovascular causes, or myocardial infarction or stroke during 5 years of treatment with ramipril 10 mg/day relative to placebo.Lisinopril is an ACE inhibitor indicated for use in hypertension, heart failure and post-myocardial infarction. As an antihypertensive agent the drug is effective and generally well tolerated in patients with type 1 or 2 diabetes mellitus and in those with early or overt nephropathy.In the Swedish Treatment of Old People (STOP) Hypertension 2 trial, there was no difference in the relative risk of cardiovascular death between those assigned to ACE inhibitors (lisinopril or enalapril), calcium channel blockers (felodipine or isradipine) or ‘conventional’ antihypertensive therapy (thiazide diuretics or β blockers); treatment effects did not differ significantly between diabetic and nondiabetic patients (10.9% of the 6614 patients had diabetes mellitus). Importantly, lower frequencies of nonfatal or fatal myocardial infarction [relative risk (RR) 0.77; 95% confidence interval (CI) 0.61 to 0.96] and congestive heart failure (RR 0.78; CI 0.83 to 0.97) were detected during 4 years’ treatment with lisinopril or enalapril than felodipine or isradipine in this study.Lisinopril reduced albumin excretion rates in patients with type 1 or 2 diabetes mellitus. In the 2-year EURODIAB Controlled Trial of Lisinopril in IDDM (EUCLID) study, albumin excretion rates decreased by 49.7% relative to placebo in normotensive patients with type 1 diabetes mellitus and microalbuminuria during treatment with lisinopril 10 to 20 mg/day. Progression of retinopathy was attenuated in normotensive patients with type 1 diabetes mellitus during treatment with lisinopril in this study.In conclusion, lisinopril, like other ACE inhibitors should be considered a first-line agent for reducing BP and attenuating nephropathy in patients with type 1 or 2 diabetes mellitus.     

A prospective study of whole-grain intake and risk of type 2 diabetes mellitus in US women

OBJECTIVES: This study examined the association between intake of whole vs refined grain and the risk of type 2 diabetes mellitus. METHODS: We used a food frequency questionnaire for repeated dietary assessments to prospectively evaluate the relation between whole-grain intake and the risk of diabetes mellitus in a cohort of 75,521 women aged 38 to 63 years without a previous diagnosis of diabetes or cardiovascular disease in 1984. RESULTS: During the 10-year follow-up, we confirmed 1879 incident cases of diabetes mellitus. When the highest and the lowest quintiles of intake were compared, the age and energy-adjusted relative risks were 0.62 (95% confidence interval [CI] = 0.53, 0.71, P trend < .0001) for whole grain, 1.31 (95% CI = 1.12, 1.53, P trend = .0003) for refined grain, and 1.57 (95% CI = 1.36, 1.82, P trend < .0001) for the ratio of refined- to whole-grain intake. These findings remained significant in multivariate analyses. The findings were most evident for women with a body mass index greater than 25 and were not entirely explained by dietary fiber, magnesium, and vitamin E. CONCLUSIONS: These findings suggest that substituting whole- for refined-grain products may decrease the risk of diabetes mellitus.     

A strong inverse relationship between PAI-1 and Lp(a) in hypertensive Type 2 diabetic patients

Thrombophilia with a contemporary reduction of fibrinolytic activity has been observed both in diabetes mellitus and hypertension. Previously, we found a relationship between plasminogen activator inhibitor Type 1 (PAI-1) and lipoprotein(a) [Lp(a)] in Type 2 diabetes mellitus patients without complications. We hypothesised that this relationship could be due to a compensatory mechanism able to lower the risk of hypofibrinolysis as found in Type 2 diabetes mellitus. The present work was aimed at investigating the influence of concurrent hypertension and diabetes mellitus on the plasma levels of these two fibrinolytic inhibitors. In addition, other risk factors, known to influence the fibrinolytic parameters, were taken into account. Forty-nine Type 2 nonhypertensive diabetic patients without complications, 47 Type 2 hypertensive diabetic patients without complications, 54 non-diabetic hypertensive subjects without complications as well as 87 control subjects were studied. Plasma concentrations of Lp(a), PAI-1 antigen and activity, and the main parameters of oxidative, lipo- and glycometabolic balance were determined. Significant statistical differences between diabetic and non-diabetic subjects were found concerning triglycerides and antioxidant defence (p<0.01). Analysis of variance showed the F test statistically significant in evaluating the Log PAI-1/Lp(a) (p = 0.02). Correlation analysis between Log PAI-1 antigen and Lp(a) was significant in non-hypertensive diabetic patients, as expected (r = -0.38, p<0.01), and even stronger in hypertensive diabetic patients (r = -O.72,p<0.01). These results allow to hypothesise that the relationship between PAI-1/Lp(a) could be determinant in avoiding vascular complications due to diabetes mellitus and hypertension.     

Snoring as a risk factor for type II diabetes mellitus: a prospective study

To examine the association between snoring and risk of developing type II diabetes mellitus, the authors analyzed data from the Nurses' Health Study cohort. This analysis included 69,852 US female nurses aged 40-65 years without diagnosed diabetes, cardiovascular disease, or cancer at baseline in 1986. Snoring patterns were ascertained by questionnaire. During 10 years of follow-up, 1,957 women were diagnosed with type II diabetes. In analyses adjusted for age and body mass index, snoring was associated with risk of diabetes (for occasional snoring vs. nonsnoring, relative risk (RR) = 1.48 (95% confidence interval (CI): 1.29, 1.70); for regular snoring vs. nonsnoring, RR = 2.25 (95% CI: 1.91, 2.66); p for trend < 0.0001). Further adjustment for other diabetes risk factors and sleeping-related covariates only slightly attenuated the risk (for occasional snoring, RR = 1.41 (95% CI: 1.22, 1.63); for regular snoring, RR = 2.03 (95% CI: 1.71, 2.40); p for trend < 0.0001). Analyses stratified by body mass index, smoking history, or parental history of diabetes showed a consistent association between snoring and diabetes within the categories of these variables. These results suggest that snoring is independently associated with elevated risk of type II diabetes.     

Serum uric acid and risk for development of hypertension and impaired fasting glucose or Type II diabetes in Japanese male office workers

We examined the association of serum uric acid (SUA) with development of hypertension (blood pressure 140/90 mmHg and/or medication for hypertension) and impaired fasting glucose (IFG) (a fasting plasma glucose level 6.1–6.9 mmol/l) or Type II (non-insulin-dependent) diabetes (a fasting plasma glucose level 7.0 mmol/l and/or medication for diabetes) over a 6-year follow-up among 2310 Japanese male office workers aged 35–59 years who did not have hypertension, IFG, Type II diabetes, or past history of cardiovascular disease at study entry. After controlling for potential predictors of hypertension and diabetes, the relative risk for hypertension compared with quintile 1 of SUA level was 1.27 [95% confidence interval (CI): 1.00–1.62] for quintile 2, 1.34 (95% CI: 1.08–1.74) for quintile 3, 1.48 (95% CI: 1.18–1.89) for quintile 4, and 1.58 (95% CI: 1.26–1.99) for quintile 5 (p for trend <0.001). The respective multivariate-adjusted relative risks for IFG or Type II diabetes compared with quintile 1 of SUA level were 1.55 (95% CI: 0.95–2.63), 1.62 (95% CI: 0.98–2.67), 1.61 (95% CI: 1.01–2.58), and 1.78 (95% CI: 1.11–2.85) (p for trend = 0.030). The association between SUA level and risk for hypertension and IFG or Type II diabetes was stronger among men with a body mass index (BMI) <24.2 kg/m² than among men with a BMI 24.2 kg/m², although the absolute risk was greater in more obese men. These results indicate that SUA level is closely associated with an increased risk for hypertension and IFG or Type II diabetes.     

辽宁省成年人糖尿病患病现况及其影响因素分析

目的 描述辽宁省成年人糖尿病患病情况并探索相关影响因素,为制定适合本省的防治策略提供科学依据。方法 采用多阶段分层随机整群抽样的方法,对辽宁省17 857名成年居民进行问卷调查及体格检查,应用Logistic回归模型对糖尿病患病的相关因素进行分析。结果 辽宁省成年人糖尿病患病率为13.00%,糖尿病知晓率为61.84%,治疗率为71.31%,控制率为35.16%。年龄（45~岁:OR=1.824,95%CI:1.526~2.181;≥60岁:OR=2.077,95%CI:1.730~2.492）、体质指数（body mass index,BMI）分级（超重:OR=1.213,95%CI:1.096~1.343;肥胖:OR=1.547,95%CI:1.338~1.787）、自报血脂异常（OR=2.686,95%CI:2.308~3.126）和患高血压（OR=1.807,95%CI:1.630~2.004）是糖尿病患病的危险因素,农村居民（OR=0.866,95%CI:0.788~0.952）、受教育程度较高（高中:OR=0.859,95%CI:0.756~0.975;大专及以上:OR=0.678,95%CI:0.576~0.798）、中等收入水平（OR=0.738,95%CI:0.585~0.931）及饮酒（OR=0.779,95%CI=0.682~0.890）是糖尿病患病的保护因素。结论 辽宁省成年人糖尿病患病率和知晓率较高,治疗率和控制率较低,应针对重点人群采取有效措施积极干预。     

Risk factors for uterine leiomyoma: a practice-based case-control study. II. Atherogenic risk factors and potential sources of uterine irritation

In this case-control study, the authors analyzed associations of uterine leiomyoma with atherogenic risk factors and potential sources of uterine irritation. The study included 318 case women with uterine leiomyoma that was first confirmed between 1990 and 1993 in the Baltimore, Maryland, area and 394 controls selected from women visiting the same gynecologists' offices for routine reasons. Telephone interviews were conducted with 77.8% of eligible cases and 78.0% of eligible controls. Compared with participants with no hypertension history, increased risks were observed among participants with any history of hypertension (odds ratio (OR) = 1.7; 95% confidence interval (CI): 1.0, 2.8), hypertension requiring medication (OR = 2.1; 95% CI: 1.1, 4.1), hypertension diagnosed at ages less than 35 years (for hypertension requiring medication, OR = 2.7; 95% CI: 1.0, 7.6), and hypertension of 5 or more years' duration (for hypertension requiring medication, OR = 3.1; 95% CI: 1.2, 8.2). Estimates of associations with diabetes history were very imprecise but followed similar patterns. Adjusted associations were observed with pelvic inflammatory disease (three or more episodes vs. none: OR = 3.7; 95% CI: 0.9, 15.9), chlamydial infection (history vs. no history: OR = 3.2; 95% CI: 0.8, 13.7), and use of an intrauterine device when it caused infectious complications (use vs. no use: OR = 5.3; 95% CI: 1.8, 16.3). Risk of uterine leiomyoma was also associated in a graded fashion with frequency of perineal talc use (daily use vs. no use: OR = 2.2; 95% CI: 1.4, 3.1). The authors conclude that nonhormonal factors may influence risk of uterine leiomyoma.     

Survival benefits of metabolic syndrome among older men aged 75 years and over in Taiwan

Background

Metabolic syndrome (MetS) was common in the elderly, but its prognostic significance in older old population remained unclear. The main purpose of this study was to evaluate the survival impact of MetS among older men aged 75 and over in Taiwan.

Methods

From 2008, residents aged 75 years and older of Banciao Veterans Home were invited for study and were followed for 3 years. All participants received history taking, physical examinations, and laboratory tests. Mortality was determined by Veteran Affairs Death Registry, which was linked to the National Death Registry.

Results

Overall, 680 men (mean age: 82.5±47 years) were enrolled for study and the prevalence of MetS was 31.6%. During the follow-up period, 140 (20.6%) participants died, and the causes of death included infectious diseases (62, 9.1%), cardiovascular disease (37, 5.4%), cancer (20, 2.9%), and others (21, 3.1%). MetS subjects had a significantly higher prevalence of hypertension, diabetes mellitus, and having higher body mass index, waist circumferences, systolic blood pressure, fasting blood glucose, serum triglyceride and lower HDL-C level than non-MetS subjects. However, MetS subjects were less likely to die during study period (16.3% vs. 22.6%, P=0.059). Multivariate logistic regression showed that older age (OR: 1.04, 95% C.I.: 1.00?C1.08, P=0.04), diabetes mellitus (OR: 2.10, 95% CI: 1.34?C3.30, P=0.001) were independent risk factors for mortality; and serum total cholesterol and triglyceride were protective factors (OR: 0.99, 95% CI: 0.99?C1.00, P=0.037 for cholesterol; OR: 0.99, 95% CI: 0.99?C1.00, P=0.013 for triglyceride). Adjusted for age, diabetes mellitus, serum levels of total cholesterol, and triglyceride, MetS played a potential trend of survival benefits among study subjects (HR: 0.71, 95% CI: 045?C1.12, P=0.144).

Conclusions

The prevalence of MetS among men aged 75 years and over was 31.6%, and the 3-year mortality rate was 20.6%. Older age, diabetes mellitus, lower serum cholesterol and lower serum triglyceride were independent risk factors for mortality. Further investigation is needed to clarify the prognostic impact of MetS in older adults.     

Combined use of brain natriuretic peptide and C-reactive protein for predicting cardiovascular risk in outpatients with type 2 diabetes mellitus

Appropriate tools are necessary for predicting cardiovascular events in patients with diabetes mellitus because of their high incidence. In this study, we assessed whether a combination of brain natriuretic peptide (BNP) and C-reactive protein (CRP) measurement were useful prognosticators in patients with type 2 diabetes mellitus. One hundred and nine patients with type 2 diabetes mellitus, aged 52 to 93 years, were examined at outpatient clinics for blood, urinary samples, and echocardiography. They were then followed prospectively. During the average follow-up period of 30 months (range, 3 to 37), 15 patients (14%) had cardiovascular events: This was the first event in 5 patients and a recurrence in 10. Cox regression analysis showed that the past event (hazard ratio [HR] 4.819 [95% confidence interval (CI): 1.299-17.881]; p = 0.019) and plasma BNP level (HR 1.007 [95% CI: 1.002-1.012]; p = 0.010] were independently significant factors for the cardiovascular events during the follow-up period. Patients with plasma BNP > or =53 pg/mL and CRP > or =0.95 mg/dL demonstrated the highest incidence in cardiovascular event, compared to those categorized into either or both low levels of BNP and CRP. This study suggests that combination of plasma BNP and CRP measurement provides the additive prognostic information of cardiovascular events in patients with type 2 diabetes mellitus.     

2型糖尿病人群中高尿酸血症与心血管病死亡风险的队列研究

目的 探讨2型糖尿病(type 2 diabetes mellitus,T2DM)队列人群中高尿酸血症与心血管病死亡风险的关系.方法 研究对象为江苏省常熟市的T2DM队列人群.应用Cox回归模型分析基线不同尿酸水平T2DM队列人群心血管病死亡的HR值和95％CI. 结果 10 246名T2DM队列人群中累积随访59 0...     

Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture

The authors conducted a systematic review of published data on the association between diabetes mellitus and fracture. The authors searched MEDLINE through June 2006 and examined the reference lists of pertinent articles (limited to studies in humans). Summary relative risks and 95% confidence intervals were calculated with a random-effects model. The 16 eligible studies (two case-control studies and 14 cohort studies) included 836,941 participants and 139,531 incident cases of fracture. Type 2 diabetes was associated with an increased risk of hip fracture in both men (summary relative risk (RR) = 2.8, 95% confidence interval (CI): 1.2, 6.6) and women (summary RR = 2.1, 95% CI: 1.6, 2.7). Results were consistent between studies of men and women and between studies conducted in the United States and Europe. The association between type of diabetes and hip fracture incidence was stronger for type 1 diabetes (summary RR = 6.3, 95% CI: 2.6, 15.1) than for type 2 diabetes (summary RR = 1.7, 95% CI: 1.3, 2.2). Type 2 diabetes was weakly associated with fractures at other sites, and most effect estimates were not statistically significant. These findings strongly support an association between both type 1 and type 2 diabetes and increased risk of hip fracture in men and women.