Incidence of new-onset diabetes and impaired fasting glucose in patients with recent myocardial infarction and the effect of clinical and lifestyle risk factors
近期发生心肌梗死者糖尿病和空腹血糖受损的发病率及生活方式危险因素与临床治疗的影响
Background
Individuals with diabetes are at higher risk of myocardial infarction than non-diabetics. However, much less is known about the incidence of, and risk factors for, development of diabetes and impaired fasting glucose in patients who have had a myocardial infarction. We set out to estimate this incidence and investigate whether lifestyle factors such as dietary habits might alter this risk.
背景：糖尿病患者心肌梗塞的发病率大于非糖尿病患者。但是，已经发生过心肌梗塞的患者出现糖尿病或者空腹血糖损害（IFG）的机率及其危险因素不是非常清楚。我们进行该研究就是为了明确这种发病率及诸如饮食习惯等生活方式与这种危险因素的关系。
Methods
We used prospectively obtained data for 8291 Italian patients with a myocardial infarction within the previous 3 months, who were free of diabetes (determined by medication use, a physician-reported diagnosis, or fasting glucose ≥7 mmol/L) at baseline. Incidence of new-onset diabetes (new diabetes medication or fasting glucose ≥7 mmol/L) and impaired fasting glucose (fasting glucose ≥6•1 mmol/L and <7 mmol/L) were assessed at follow-up at 0•5, 1•0, 1•5, 2•5, and 3•5 years. Baseline data for body-mass index (BMI), other risk factors, dietary habits, and medications were updated during follow-up. A Mediterranean diet score was assigned according to consumption of cooked and raw vegetables, fruit, fish, and olive oil. Associations of demographic, clinical, and lifestyle risk-factors with incidence of diabetes and impaired fasting glucose were assessed with multivariable Cox proportional hazards.
方法
我们调查了8291名在过去的3个月中发生过心肌梗塞的意大利患者的数据，他们均没有糖尿病史（根据用药记录、医师报告的诊断或者是空腹血糖≥7 mmol/L确定）。在随访的0.5年、1年、1.5年、2.5年及3.5年检测评估糖尿病及IFG发生的情况，并在随访中不断更新受试对象的体质指数、其他的危险因素、饮食习惯和用药情况。地中海饮食评分根据煮熟和生食的蔬菜、水果、鱼和橄榄油来评定。人口种群、临床及生活方式危险因素与糖尿病及IFG的发病率以多变量的COX比例风险来评估。
Findings
During 26 795 person-years (mean follow-up 3•2 years [SD 0•9]), 998 individuals (12%) developed new-onset diabetes (incidence 37 cases per 1000 person-years). Of the 7533 without impaired fasting glucose at baseline, 2514 (33%) developed new-onset impaired fasting glucose or diabetes (incidence 123 cases per 1000 person-years), rising to 3859 (62%) of 6229 with the lower cutoff for impaired fasting glucose of 5•6 mmol/L (incidence 321 cases per 1000 person-years). Independent risk factors for new-onset diabetes or impaired fasting glucose included older age, hypertension, use of beta-blockers, lipid-lowering medications (protective), and diuretic use. Independent lifestyle risk-factors included higher BMI, greater BMI gain during follow-up, current smoking, a lower Mediterranean dietary score, and wine consumption of more than 1 L/day. Data for physical activity were unavailable, but inability to perform exercise testing was associated with higher incidence of diabetes and impaired fasting glucose.
结果
在26795人口年中，有998人有新发糖尿病（即每1000人口年中有37人发病）。在7533名起初没有IFG的研究对象中，有2514名（33%）发生了IFG；当将空腹血糖的标准降至5.6mmol/L时，在6229名起初没有IFG的对象中有3859（62%）最后发生了IFG。糖尿病及IFG的发生与年龄、高血压、β受体阻滞剂、降脂药（保护性）及利尿剂有关。独立的生活方式危险因素包括超出正常的BMI、BMI随时间增加、正在吸烟、地中海饮食评分较低及每天饮酒大于1升。体力活动的数据难以获得，但是运动试验的不耐受与糖尿病及IFG发病率有关。
Interpretation
Compared with population-based cohorts, patients with a recent myocardial infarction had a higher annual incidence rate of impaired fasting glucose (1•8 vs 27•5% in our study) and diabetes (0•8–1•6% compared with 3•7%) in this study. Thus, our results indicate that myocardial infarction could be a prediabetes risk equivalent. Smoking cessation, prevention of weight gain, and consumption of typical Mediterranean foods might lower this risk, which emphasises the need for guidance on diet and other lifestyle factors for patients who have had a myocardial infarction.
结论
与人群为基础的队列研究相比，在该研究中，近期发生过心肌梗死病的患者每年发生IFG (1•8 vs 27•5%)及糖尿病(0•8–1•6% vs 3•7%)的风险更高。因此，我们的研究提示心肌梗死可能是前期糖尿病的等危症。戒烟、减轻体重及进食典型的地中海食物可以降低这种风险，这也提醒我们应该对已有心肌梗死病史的患者加强饮食及其他生活方式的指导。 |
发表于 2007-8-30 00:00:39