Alcohol consumption and risk of coronary heart disease among men with type 2 diabetes mellitus

OBJECTIVES

The goal of this study was to examine the relationship between alcohol intake and risk of coronary heart disease (CHD) among men with type 2 diabetes.

BACKGROUND

Type 2 diabetes is associated with an increased risk of CHD. Emerging evidence suggests that moderate alcohol intake is associated with an important reduction in risk of CHD in individuals with type 2 diabetes.

METHODS

We studied 2,419 men who reported a diagnosis of diabetes at age 30 or older in the Health Professionals’ Follow-up study (HPFS). During 11,411 person-years of follow-up after diagnosis, we documented 150 new cases of CHD (81 nonfatal myocardial infarction [MI] and 69 fatal CHD). Relative risks (RR) were estimated from pooled logistic regression adjusting for potential confounders.

RESULTS

Alcohol use was inversely associated with risk of CHD in men with type 2 diabetes. The age-adjusted RRs corresponding to intakes of ≤0.5 drinks/day, 0.5 to 2 drinks/day and >2 drinks/day were 0.76 (95% confidence interval: [CI]: 0.52 to 1.12), 0.64 (95% CI: 0.40 to 1.02) and 0.59 (95% CI: 0.32 to 1.09), respectively, as compared with nondrinkers (p for TREND = 0.06). When we controlled for body mass index, smoking, family history of MI, hypertension, hypercholesterolemia, duration of diabetes, physical activity level, vitamin E supplements and intake of trans fat, polyunsaturated fat, fiber and folate, RRs were 0.78 (95% CI: 0.52 to 1.15), 0.62 (95% CI: 0.40 to 1.00) and 0.48 (95% CI: 0.25 to 0.94) (p for TREND = 0.03). The benefits of moderate consumption did not statistically differ by beverage type.

CONCLUSIONS

Moderate alcohol consumption is associated with lower risk of CHD in men with type 2 diabetes.     

Predicted risk of coronary heart disease among persons with type 2 diabetes

BACKGROUND: Diabetes is an independent risk factor for the development of coronary heart disease (CHD). We evaluated whether there are racial/ethnic differences in predicted probability of CHD among persons with type 2 diabetes from the 1999-2002 National Health and Nutrition Examination Survey. METHODS: Adults with type 2 diabetes without cardiovascular disease (n=585) were evaluated; the United Kingdom Prospective Diabetes Study (UKPDS) Risk Engine was used to develop estimates of CHD and Framingham Risk Score (FRS) was used to assess the 10-year CHD risk. Chi-square tests and analysis of variance were used to assess differences between racial/ethnic groups in risk factors and predicted probability for CHD. RESULTS: Risk factors for CHD differed significantly amongst the three racial/ethnic groups. Whites had lower mean A1C concentrations (7.3%+/-0.2) than blacks (8.1%+/-0.2, P<0.05) or Mexican Americans (8.1%+/-0.2, P<0.05). Systolic blood pressure was higher in blacks compared with whites (P<0.05) and in Mexican American men compared with white men (P<0.05). Total cholesterol differed insignificantly by race/ethnicity whereas high-density lipoprotein cholesterol was higher in blacks compared with whites and Mexican Americans. Blacks had the greatest 5, 10, 15, and 20-year predicted risks of CHD among men, whereas whites had the greatest predicted risks among women. When evaluated by the FRS, the 10-year predicted risk of CHD was estimated to be 22.5% by UKPDS and 17% using FRS. CONCLUSIONS: UKPDS estimates of probability of CHD were similar across race/ethnicities, indicating that the risk factors tended to balance out. Despite differences in individual risk factors, the estimated risk for CHD was similar for all persons with diabetes.     

Alcohol consumption and risk of coronary heart disease among individuals with type 2 diabetes

The epidemiologic evidence on the association between moderate alcohol intake and risk of coronary heart disease (CHD), biological mechanisms for this association, and potential hazards of alcohol intake in individuals with type 2 diabetes is reviewed here. Three prospective cohort studies have examined the association between alcohol consumption and risk of CHD among diabetics. The results indicated significant risk reductions, ranging from 34% to 79%, associated with light to moderate alcohol intake. Potential mechanisms include increased high-density lipoprotein cholesterol, decreased coagulation, and enhanced insulin sensitivity. Alcohol intake is also associated with certain risks among diabetics. However, for moderate alcohol consumption, the benefits would likely outweigh the risks.     

老年2型糖尿病合并冠心病的危险因素分析

目的 探讨老年2型糖尿病(T2DM)合并冠心病的危险因素.方法 选择2010年8月至2012年8月我院收治的120例2型糖尿病患者为研究对象,根据是否合并冠心病将其分为两组,对两组患者的临床资料进行比较分析,探讨影响T2DM合并冠心病的危险因素.结果 观察组的病程、BMI、SBP、TG、HDL-C、LDL-C、UA等指标与对照组相比差异有统计学意义(P＜0.05).Logistic回归分析结果显示,糖尿病合并冠心病的危险因素为病程＞10年、高血压、高血脂、高血清尿酸.结论 病程＞10年、高血压、高血脂、高血清尿酸为老年2型糖尿病合并冠心病的危险因素.     

A prospective study of lipoprotein(a) and risk of coronary heart disease among women with type 2 diabetes

Aims We examined the association between lipoprotein (Lp)(a) and CHD among women with type 2 diabetes.Methods Of 32,826 women from the Nurses Health Study who provided blood at baseline, we followed 921 who had a confirmed diagnosis of type 2 diabetes.Results During 10 years of follow-up (6,835 person-years), we documented 122 incident cases of CHD. After adjustment for age, smoking, BMI, glycosylated HbA₁c, triglycerides (TGs), high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and other cardiovascular risk factors, the relative risk (RR) comparing extreme quintiles of Lp(a) was 1.95 (95% CI 1.07–3.56). The association was not appreciably altered after further adjustment for apolipoprotein B₁₀₀ or several inflammatory biomarkers. Increasing levels of Lp(a) were associated with lower levels of TGs. The probability of developing CHD over 10 years was higher among diabetic women with substantially higher levels of both Lp(a) (>1.07 mol/l) and TGs (>2.26 mmol/l) than among diabetic women with lower levels (22 vs 10%, p log-rank test=0.049). Diabetic women with a higher level of only Lp(a) or TGs had a similar (14%) risk. In a multivariate model, diabetic women with higher levels of Lp(a) and TGs had an RR of 2.46 (95% CI 1.21–5.01) for developing CHD, as compared with those with lower levels of both biomarkers (p for interaction=0.413). The RRs for women with a higher level of either Lp(a) (RR=1.22, 95% CI 0.77–1.92) or TGs (RR=1.39, 95% CI 0.78–2.42) were comparable.Conclusions/interpretation Increased levels of Lp(a) were independently associated with risk of CHD among diabetic women.     

Association of C-reactive protein with coronary heart disease risk factors in patients with type 2 diabetes mellitus

The assessment of markers of systemic inflammation, such as C-reactive protein (CRP) and interleukin 6 (IL6), could be used to identify persons at high risk of coronary heart disease (CHD). This study evaluates the relationship of CRP and IL6 with CHD risk factors in patients with type 2 diabetes mellitus (DM) with CHD and age and sex matched type 2 DM controls without CHD. CRP, IL-6, total plasma homocysteine (tHcy), lipoprotein (a) [Lp(a)] and sialic acid (SA) were determined in 55 type 2 diabetic patients with CHD and 51 age- and sex-matched type 2 diabetic controls without CHD. Multivariate and logistic regression analyses were used to relate these markers with CHD risk factors. CRP (P=0.02) and tHcy (P=0.03) were significantly higher in patients with CHD compared with the control group even after correction for age and sex. IL6, Lp(a), SA and lipid parameters were not significantly different between the two groups of patients. After adjustment for potential confounders, the odds ratio (OR) for elevated CRP was 2.00 (95% confidence interval [CI], 1.12-3.58) (P=0.02) but the OR for IL6 was 3.41 95% CI, 0.70-17.17 (P=0.14). Partial correlation analyses of CRP and IL6 with other variables showed significant correlation of CRP with tHcy, and SA in patients with CHD only. Our results support the inclusion of CRP (high-sensitivity assay), in the risk assessment of diabetic subjects.     

门诊2型糖尿病合并冠心病患者临床特点分析

目的探讨门诊2型糖尿病合并冠心病患者的临床特点。方法回顾性分析中日友好医院2007年1月至2007年12月内分泌门诊528例2型糖尿病患者的临床资料。根据是否合并冠心病将患者分为冠心病组（81例）（男40例,女41例）和无冠心病组（447例）（男249例,女198例）。观察比较两组患者的临床资料。并通过logistic回归分析2型糖尿病患者冠心病的独立相关因素。结果与无冠心病组比较,冠心病组年龄较高[分别为（60±12）和（694-8）岁,t=-8．64,P〈0．05],糖尿病病程较长[分别为（9±7）和（12±7）年,t=-4．44,P〈0．05],糖化血红蛋白水平较高（分别为6．8％4-1．1％和7．4％±1．2％,t=-3．38,P〈0．05）,收缩压增高[分别为（1304-15）和（134±15）mmHg（1mmHg=0．133kPa）,t=-2．26,P〈0．05];冠心病组高血压、高血脂症、脑卒中及冠心病阳性家族史的发生率均较高（X^2=14．29、9．47、25．01、7．56,均P〈0．05）。2组血压和血脂控制达标率相当,但HbAlC〈7．0％比例在冠心病组明显低于无冠心病组（分别为48．1％和68．2％,0=12．18,P〈0．05）。Logistic多元回归分析表明年龄、糖尿病病程、HbAlC、合并脑卒中、收缩压以及他汀药的使用是2型糖尿病患者发生冠心病的独立相关因素（OR=1．08、1．11、1．47、2．72、1．03和2．41,均P〈0．05）。结论门诊2型糖尿病合并冠心病的患者表现多种危险因素并存,对于这些患者不能仅注重血糖的管理,还要注意控制血压、血脂并重视他汀类药物的使用。     

冠心病合并2型糖尿病患者冠状动脉造影分析

目的探讨冠心病(CHD)合并2型糖尿病患者的冠状动脉造影特点。方法从冠状动脉造影病例中选取454例(其中冠心病合并2型糖尿病203例,单纯冠心病251例)进行血生化和血管造影资料对比分析。结果与单纯冠心病组比较,冠心病合并2型糖尿病组甘油三酯(TG)水平高,载脂蛋白A(apoA)水平低;四支病变比例高(17.3%比9.5%,P<0.05),单支病变比例低(16.3%比26.3%,P<0.05),且血管狭窄程度重(狭窄程度≥75%的比例为66%比61.3%,P<0.05)。结论合并2型糖尿病与不合并2型糖尿病的冠心病患者的冠状动脉造影表现的差异有统计学意义,前者冠状动脉病变更加广泛和严重。     

Dietary patterns and risk of hypertension,type 2 diabetes mellitus,and coronary heart disease

Dietary pattern analysis, which reflects the complexity of dietary intake, has recently received considerable attention by nutritional epidemiologists. Two general approaches have been used to define these summary variables in observational studies. The so-called a posteriori approach builds on statistical exploratory methods, whereas the so-called a priori approach focuses on the construction of pattern variables that reflect hypothesis-oriented patterns based on available scientific evidence for specific diseases. Several studies, both observational and clinical, suggest that these measures of overall diet predict disease risk, and that its application might be especially valuable in the development of food-based dietary guidelines. In this review, we describe different patterning approaches and the available evidence regarding the relationships between dietary patterns and risk of hypertension, type 2 diabetes mellitus, and coronary heart disease.     

胱抑素C与2型糖尿病并发冠状动脉粥样硬化性心脏病的关系

目的探讨胱抑素C(cystatin C,Cys-C)在2型糖尿病(type 2 diabetes mellitus,T2DM)并发冠状动脉粥样硬化性心脏病(coronary heart disease,CHD)发生、发展过程中的作用及其相关性。方法入选符合纳入标准T2DM组(B组)70例、T2DM合并CHD组(C组)70例;另外,选择同期健康体检者35名作为正常对照组(A组)。收集所有研究对象的年龄、体质量指数(body mass index,BMI)、腰臀比(waist to hip ratio,WHR)、血压、血脂、空腹血糖、空腹胰岛素、糖化血红蛋白,超敏C反应蛋白等临床资料并进行统计分析。用全自动生化分析仪测定空腹血浆Cys-C浓度。结果 C组血浆Cys-C浓度高于A组及B组,差异有统计学意义[(1.34±0.63)mg/L vs.(0.74±0.14)mg/L,P<0.05;(1.34±0.63)mg/L vs.(0.87±0.36)mg/L,P<0.05];但A组和B组血浆Cys-C浓度比较,差异无统计学意义(P>0.05)。Pearson相关分析结果显示,Cys-C在B组与年龄(r=0.254,P=0.034)、高敏C反应蛋白(r=0.238,P=0.047)呈正相关;在C组与FPG空腹血糖(r=0.273,P=0.022)、脂蛋白(r=0.426,P=0.000)(a)、高敏C反应蛋白(r=0.305,P=0.010)呈正相关。Logistic逐步回归分析显示,年龄、WHR、脂蛋白(a)、Cys-C是T2DM并发CHD的独立危险因素;而高密度脂蛋白胆固醇是T2DM并发CHD的保护因素。结论 T2DM并发CHD患者血浆Cys-C浓度显著升高,它是T2DM并发CHD的独立危险因素。     

Development and validation of a total coronary heart disease risk score in type 2 diabetes mellitus

There are no validated risk scores for predicting coronary heart disease (CHD) in Chinese patients with type 2 diabetes mellitus. This study aimed to validate the UKPDS risk engine and, if indicated, develop CHD risk scores. A total of 7,067 patients without CHD at baseline were analyzed. Data were randomly assigned to a training data set and a test data set. Cox models were used to develop risk scores to predict total CHD in the training data set. Calibration was assessed using the Hosmer-Lemeshow test, and discrimination was examined using the area under the receiver-operating characteristic curve in the test data set. During a median follow-up of 5.40 years, 4.97% of patients (n = 351) developed incident CHD. The UKPDS CHD risk engine overestimated the risk of CHD with suboptimal discrimination, and a new total CHD risk score was developed. The developed total CHD risk score was 0.0267 x age (years) - 0.3536 x sex (1 if female) + 0.4373 x current smoking status (1 if yes) + 0.0403 x duration of diabetes (years) - 0.4808 x Log(10) (estimated glomerular filtration rate [ml/min/1.73 m(2)]) + 0.1232 x Log(10) (1 + spot urinary albumin-creatinine ratio [mg/mmol]) + 0.2644 x non-high-density lipoprotein cholesterol (mmol/L). The 5-year probability of CHD = 1 - 0.9616(EXP(0.9440 x [RISK SCORE - 0.7082])). Predicted CHD probability was not significantly different from observed total CHD probability, and the adjusted area under the receiver-operating characteristic curve was 0.74 during 5 years of follow-up. In conclusion, the UKPDS CHD risk engine overestimated the risk of Chinese patients with type 2 diabetes mellitus and the newly developed total CHD risk score performed well in the test data set. External validations are required in other Chinese populations.     

2型糖尿病合并冠心病危险因素分析

目的 分析２型糖尿病合并冠心病危险因素。方法 应用多因素Ｌｏｇｉｓｔｉｃ回归,分析了４０５例２型糖尿病患者有关冠心病的危险因素。结果 （１）２型糖尿病病人冠心病发生率为２６．２％;（２）年龄,糖尿病病程,高血压,体重指数,空腹血清Ｃ肽,甘油三酯,血清尿酸７个因素与Ⅱ型糖尿病病人冠心病发病有关。结论除了常见的冠心病危险因素外,为了防止２型糖尿病病人冠心病的发生,亦应注意控制高胰岛素血症,高甘油三酯血     

Diet and risk of coronary heart disease and type 2 diabetes

A high intake of saturated fat is an important risk factor for coronary heart disease (CHD) and type 2 diabetes. However the declining rates of CHD in many affluent societies and the steady increase in type 2 diabetes worldwide suggest that these important causes of serious morbidity and premature mortality have differing risk or protective factors worldwide. Changed macronutrient composition, reduced cigarette smoking, and improved treatment of risk factors and acute cardiac events might explain the reduction in risk of CHD, whereas the increasing rates of obesity are probably the most important explanation for the increase in diabetes. Coronary risk factors associated with diabetes could outweigh improvements in conventional cardiovascular risk factors such that the decline in CHD could be stopped or reversed unless rates of obesity can be reduced. Reduced intake of saturated fatty acids and other lifestyle interventions aimed at lowering rates of obesity are the changes most likely to reduce the epidemic numbers of people with type 2 diabetes and CHD.     

冠心病合并2型糖尿病患者的冠状动脉造影特点

目的　探讨冠心病合并 2型糖尿病 (T2 DM)患者的冠状动脉造影特点。方法　对 10 7例冠心病合并 T2 DM及6 77例非糖尿病冠心病患者冠状动脉造影资料进行统计分析。结果　冠心病合并 T2 DM患者的冠状动脉造影结果显示 ,多枝病变多于单枝、受累血管数目较多、左主干受累、弥漫性病变病例多见 ,均显著高于非糖尿病冠心病患者(P<0 .0 5 )。闭塞血管数目在糖尿病患者也高于非糖尿病患者 ,但未达到显著统计学差异。结论　冠心病合并T2 DM患者的冠状动脉血管受累明显较非糖尿病冠心病患者严重且病变更为弥漫     

2型糖尿病发生冠心病相关危险因素的研究

目的探讨2型糖尿病患者发生冠心病的相关危险因素。方法选择2型糖尿病患者150例,根据是否合并冠心病分为2组,单纯2型糖尿病患者组(A组)82例和2型糖尿病合并冠心病患者组(B组)68例。另选择同期健康体检者60例作为对照组,测定各组的同型半胱氨酸、高敏C反应蛋白、凝血酶原时间、活化部分凝血酶时间、纤维蛋白原和D-二聚体。结果与对照组比较,A组和B组患者同型半胱氨酸、高敏C反应蛋白和D-二聚体差异有统计学意义(P<0.05);与A组比较,B组同型半胱氨酸、高敏C反应蛋白和D-二聚体差异有统计学意义(P<0.05)。多因素logistic回归分析显示,同型半胱氨酸、高敏C反应蛋白和D-二聚体均为冠心病的危险因素。3组凝血酶原时间、活化部分凝血酶时间、纤维蛋白原比较差异无统计学意义(P>0.05)。结论同型半胱氨酸、高敏C反应蛋白和D-二聚体均是2型糖尿病患者发生冠心病的高风险因素。     

2型糖尿病伴冠心病患者血清胱抑素C水平及其意义

目的:探讨血清胱抑素C(Cys C)水平与2型糖尿病伴冠心病的关系。方法:收集40例单纯2型糖尿病患者(DM组)、120例2型糖尿病伴冠心病(CHD)患者(DM+CHD组)及40例健康者(对照组)的血清。分别测定基础代谢率、血压、血脂、血清糖化血红蛋白及Cys C水平。结果:血清Cys C水平在DM组[(1.58±0.78)mg/L]、DM+CHD组[(2.12±0.94)mg/L]较对照组[(0.82±0.23)mg/L]明显升高,差异有统计学意义(P<0.01),DM+CHD组明显高于DM组(P<0.05)。冠状动脉狭窄支数越多,血清Cys C水平越高。结论:2型糖尿病伴CHD患者的血清Cys C水平增高,且随冠状动脉狭窄病变支数的相应增加呈增高趋势,提示Cys C在2型糖尿病伴CHD的发生发展中起一定作用。