Diabetes, fibrinogen, and risk of cardiovascular disease: the Framingham experience

The influence of fibrinogen on the risk of cardiovascular disease is examined over 16 years of follow-up in 1314 subjects who were initially free of cardiovascular disease in the Framingham Study. Of these subjects, 46 men and 43 women developed diabetes, and 56 men and 53 women had blood sugar levels that exceeded 120 mg/dl. Diabetes predisposed subjects to all of the 408 major cardiovascular disease outcomes. Diabetics had higher levels of fibrinogen, hypertension, hypertriglyceridemia, and obesity, but lower HDL cholesterol values. The influence of diabetes on cardiovascular disease was greatly dependent on these coexistent risk factors, but there was a substantial independent effect of glucose intolerance when all the standard risk factors had been taken into account. There was a rise in fibrinogen values throughout the range of blood sugar levels, which suggests a thrombogenic explanation for the unique diabetic effect. However, multivariate analysis indicates no further reduction in diabetic cardiovascular risk ratios after adjustment for fibrinogen; thus, there is a residual effect for glucose intolerance after all of the standard risk factors and fibrinogen have been taken into account.     

超重、肥胖及其与糖尿病的患病风险分析

目的 调查中国40岁以上社区人群超重、肥胖的基线数据，并探讨超重、肥胖与糖尿病(DM)和糖耐量低减(IGT)的患病风险。方法 在1997—1998年随机抽取我国22个社区人群，测量研究对象的体重指数(BMI)，腰围(WC)，腰臀比(WHR)以诊断肥胖。并按WHO标准筛查了DM和IGT。结果 获得了我国≥40岁人群的年龄调整超重率(男34．88％，女34．94％)和年龄调整肥胖率(男9．75％，女15．48％)等指标的基线数据。超重、肥胖率随地区和人群有很大的差别。随超重，肥胖程度增加，可明显加大DM(OR值，男性：1．90；女性：1．75)和IGT(OR值，男性：1．65；女性：1．46)的患病风险，并且这一患病风险与年龄增长无关。WC和WHR的增加，不仅与年龄增长有关，而且与增加DM和IGT的患病风险也有关。结论我国≥40岁人群中的超重和肥胖人数在增加。超过限值的BMI，WC和WHR是易患DM，IGT的危险因素。     

A general cardiovascular risk profile: the Framingham Study.

Persons at high risk of cardiovascular disease can be effectively identified from a measurement of their serum cholesterol and blood pressure, a smoking history, an electrocardiogram and a determination of glucose intolerance. One general function for identifying persons at high risk of cardiovascular disease is also effective in identifying persons at risk for each of the specific diseases, coronary heart disease, atherothrombotic brain infarction, hypertensive heart disease and intermittent claudication, even though the variables used have a different impact on each particular disease. The 10 percent of persons identified with use of this function as at highest risk accounted for about one fifth of the 8 year incidence of coronary heart disease and about one third of the 8 year incidence of atherothrombotic brain infarction, hypertensive heart disease and intermittent claudication. Hence the function provides an economic and efficient method of identifying persons at high cardiovascular risk who need preventive treatment and persons at low risk who need not be alarmed about one moderately elevated risk characteristic.     

Serum potassium and risk of cardiovascular disease: the Framingham heart study

BACKGROUND: Published studies of the association between serum potassium concentration and risk for cardiovascular disease in community-based populations have reported conflicting results. We sought to determine the association between serum potassium concentration and cardiovascular disease risk in the Framingham Heart Study. METHODS: A total of 3151 participants (mean age, 43 years; 48% men) in the Framingham Heart Study who were free of cardiovascular disease and not taking medications affecting potassium homeostasis had serum potassium levels measured (1979-1983). Proportional hazards models were used to determine the association of serum potassium concentration at baseline with the incidence of cardiovascular disease at follow-up. RESULTS: During mean follow-up of 16 years, 313 cardiovascular disease events occurred, including 46 cardiovascular disease-related deaths. After adjustment for age, serum potassium level was marginally associated with risk of cardiovascular disease (hazard ratio [HR] per 1 mg/dL increment, 1.03; 95% confidence interval [CI], 1.00-1.05; P =.02). However, after further adjustment for multiple confounders, serum potassium level was not significantly associated with cardiovascular disease risk (HR, 1.00; 95% CI, 0.98-1.03). There were no significant associations between serum potassium level and cardiovascular disease-related death in either age- and sex-adjusted models (HR, 1.06; 95% CI, 0.99-1.12) or multivariable-adjusted models (HR, 1.04; 95% CI, 0.97-1.11). CONCLUSION: In our community-based sample of individuals free of cardiovascular disease and not taking medications that affect potassium homeostasis, serum potassium level was not associated with risk of cardiovascular disease.     

Autoantibodies to oxidized LDL and cardiovascular risk: the Framingham Offspring Study

BACKGROUND: The relation between measures of oxidation of lipid particles and cardiovascular disease has not been extensively investigated prospectively on a population basis. METHODS: A community cohort of 1192 men and 1427 women with measures of IgG antibodies to oxidized LDL were followed 8 years for the development of initial coronary heart disease (CHD) and cardiovascular disease (CVD) events. RESULTS: Levels of IgG autoantibodies to a form of oxidized LDL were significantly associated with age in both sexes, positively with fibrinogen in men and negatively with HDL cholesterol in women. In sex-specific models that adjusted for age alone or those that adjusted for age, cholesterol, HDL cholesterol, smoking, and diabetes mellitus, there was no relation between level of antibodies to oxidized LDL and the development of CHD or CVD. CONCLUSION: Autoantibodies to oxidized LDL were strongly related to age and were not related to incident CHD or CVD over 8 years of follow up.     

Estimating cardiovascular disease risk and the metabolic syndrome: a Framingham view.

The metabolic syndrome as currently defined by the Adult Treatment Panel III includes multiple components. This article describes the background for these components' inclusion in the syndrome,measurement of these factors, and the appropriate interventions.The factors are highly interrelated and the true utility of this diagnostic entity is under critical evaluation as new and existing data are evaluated concerning the role of the syndrome in the development of vascular disease and other clinical outcomes.     

Plasma renin and risk of cardiovascular disease and mortality: the Framingham Heart Study.

AIMS: Previous studies relating plasma renin to cardiovascular disease (CVD) and mortality yielded conflicting results. We related plasma renin to incidence of CVD and mortality in 3408 individuals (mean age 59; 53% women) and in a hypertensive subset (n = 1413). METHODS AND RESULTS: On follow-up (mean 7.1 years), 176 participants (122 hypertensives) developed CVD and 215 individuals (127 hypertensives) died. Overall, log-renin was associated with mortality [multivariable-adjusted hazards ratio (HR) per SD increment: in whole sample, 1.14, 95% confidence interval (CI) 1.00-1.30, P = 0.046; hypertensives, 1.16, 95% CI 1.00-1.35, P = 0.046], but relations varied over time (P < 0.02). Log-renin was associated with mortality at 2.5 years of follow-up (HR per SD increment: whole sample at 2.5 years, 1.23, 95% CI 1.04-1.45; hypertensives at 2 years, 1.28, 95% CI 1.06-1.54), but not during longer follow-up (HR per SD increment at 5 years: whole sample, 1.02, 95% CI 0.80-1.29; hypertensives, 0.98, 95% CI 0.74-1.30). The time-dependent relation of renin and mortality risk was maintained upon excluding participants with prevalent CVD. Renin was not associated with CVD incidence (HR per SD increment log-renin: whole sample, 0.99, 95% CI 0.85-1.14; hypertensives, 0.96, 95% CI 0.82-1.12). CONCLUSION: Higher plasma renin was associated with greater short-term mortality but not with CVD incidence in the community.     

人体测量学指标与心血管疾病及其危险因素

体重指数、腰围、臀围、腰臀比、腰身比等反映肥胖的人体测量学指标与糖尿病、高血压、脂代谢异常等密切相关.横断面及前瞻性研究均证明,人体测量学指标能预测糖尿病、高血压及脂代谢异常的发生.但各指标具有种族差异性,应针对不同人群特点制订相应的标准及控制目标.     

人体测量学指标与心血管疾病及其危险因素

体重指数、腰围、臀围、腰臀比、腰身比等反映肥胖的人体测量学指标与糖尿病、高血压、脂代谢异常等密切相关.横断面及前瞻性研究均证明,人体测量学指标能预测糖尿病、高血压及脂代谢异常的发生.但各指标具有种族差异性,应针对不同人群特点制订相应的标准及控制目标.     

人体测量学指标与心血管疾病及其危险因素

体重指数、腰围、臀围、腰臀比、腰身比等反映肥胖的人体测量学指标与糖尿病、高血压、脂代谢异常等密切相关.横断面及前瞻性研究均证明,人体测量学指标能预测糖尿病、高血压及脂代谢异常的发生.但各指标具有种族差异性,应针对不同人群特点制订相应的标准及控制目标.     

Exenatide as a treatment for diabetes and obesity: Implications for cardiovascular risk reduction

Among the challenges in improving outcomes in patients with diabetes is effectively implementing existing pharmacotherapies. However, current therapies for diabetes are often limited by adverse effects such as edema, hypoglycemia, and weight gain. Understanding the role of the incretin effect on the pathophysiology of diabetes has led to the development of new therapeutic agents. Exenatide is the first in a new class of agents termed “incretin mimetics,” which replicate several glucoregulatory effects of the endogenous incretin hormone, glucagon-like peptide-1. In clinical trials, patients with type 2 diabetes treated with exenatide demonstrate sustained improvements in glycemic control, with reductions in fasting and postprandial glucose levels and improvements in glycosylated hemoglobin levels. Improvements in glycemic control with exenatide are coupled with reductions in body weight. Lipid parameters, blood pressure, and C-reactive protein have been shown to improve favorably in patients treated with exenatide. The sustained glycemic improvements and progressive reduction in body weight with exenatide treatment support a shift toward a more favorable cardiovascular risk profile and may have a positive impact on decreasing the risk of associated long-term complications.     

Framingham cardiovascular disease risk scores and incident frailty: the English longitudinal study of ageing

Cross-sectional studies show that frailty is common in older people with cardiovascular disease. Whether older people at higher risk of developing cardiovascular disease are more likely to become frail is unclear. We used multinomial logistic regression to examine the prospective relation between Framingham cardiovascular disease risk scores and incidence of physical frailty or pre-frailty, defined according to the Fried criteria, in 1,726 men and women aged 60 to over 90 years from the English Longitudinal Study of Ageing who had no history of cardiovascular disease at baseline. Men and women with higher Framingham cardiovascular risk scores were more likely to become frail over the 4-year follow-up period. For a standard deviation higher score at baseline, the relative risk ratio (95 % confidence interval) for incident frailty, adjusted for sex and baseline frailty status, was 2.76 (2.18, 3.49). There was a significant association between Framingham cardiovascular risk score and risk of pre-frailty: 1.69 (1.46, 1.95). After further adjustment for other potential confounding factors, the relative risk ratios for frailty and pre-frailty were 2.15 (1.68, 2.75) and 1.50 (1.29, 1.74), respectively. The associations were unchanged after excluding incident cases of cardiovascular disease. Separate adjustment for each component of the risk score suggested that no single component was driving the associations between cardiovascular risk score and incident pre-frailty or frailty. Framingham cardiovascular risk scores may be useful for predicting the development of physical frailty in older people. We now need to understand the biological mechanisms whereby cardiovascular risk increases the risk of frailty.