understandingtherisingtideofdiabeticcvd

understandingtherisingtideofdiabeticcvd内容摘要：

mmHg) mm Hg diabetics Diabetic Men Men Wom e n Wom e nFHS SH S FHS SH S16019 9 Ref Ref Ref Ref20023 9 24027 9 = 28 0 RR for Total Cholesterol in Framingham vs Strong Heart Study Implementation of Findings • Health Care Providers – Increased awareness of CVD because of SHS – Development of Indianspecific “Framingham” predictive equation • Prevention – Stop Atherosclerosis in Native Diabetics Study – 3year randomized intervention for LDL and BP • usual targets • LDL 75mg/dl, BP 115/75 • endpoint carotid and coronary ECHO • Conventional Risk Factors • New Risk Factors Women Men Macro albuminuria Women Men Micro albuminuria Age and CenterAdjusted Hazard Ratios for Albuminuria as Predictor of CVD Albuminuria and LV Structure and Function NoAlb u m in u riaN=68 5Micro AlbN=51 9Macro AlbN=37 2LV M ass ( g ms) 155  3 6 a160  3 9 a181  5 0 bLV Hy p ertro ph y (%) 2 3 % a3 1 % b4 9 % cFractio n al Sh o rten in g (%) 35  6 a35  6 a33  8 bEjectio n Fr action (%) 64  8 a63  9 a60  1 2 bValues with same superscript are not significantly different Prevalence of Abnormal Diastolic Function Based on Albuminuria Status 010203040%n or m al m i c r o m ac r o* Adjusted covariates: Age, gender, BMI, SBP, HgbA1C, coronary artery disease, ejection fraction, LV mass NS P= P Distribution of Fasting Insulin Levels Strong Heart Study 051015202530351 s t T e rt i l e 2 n d t e rt i l e 3 rd T e rt i l eT e rt i l e o f H O M A I RPercent (%)051015202530A b s e n t Pre s e n tA T P I I I M e t a b o l i c S y n d r o m ePercent (%)IR and MS as Predictors of Diabetes 0123456789101 s t T e rt i l e 2 n d t e rt i l e 3 rd T e rt i l eT e r ti l e o f H O M A I RPercent (%)012345678910A b s e n t Pre s e n tA T P I I I M e t a b o l i c S y n d r o m ePercent (%)IR and MS as Predictors of CVD • The insulin resistance syndrome is not a strong determinant of CVD in nondiabetic American Indians • Among the CVD risk factors and parameters of CV function, only lipoproteins and PAI1 change significantly with increasing IR • IR leads to diabetes before it leads to CVD Inflammatory Markers? Age and CenterAdjusted Hazard Ratios for Fibrinogen as Predictor of CVD Women Men Elevated Fibrinogen and ECHO Abnormalities O R ( ad j) 95 % CIECH O LVH 1. 38 1. 101 .7 3 Art. S ti ff ness 1. 45 1. 111 .8 8 Low Co nt r. 1. 05 0. 701 .5 7A ny of a bov e 1. 51 1. 221 .8 7CRP Population Comparisons Study Median/ Mean* Pop. based Comments SHS Yes Am. Indian NHANES Yes US 40 years PRINCE Yes US 21 years CHS * Yes US AV = 77 years IRAS * No Diabetes NHS No Women MRFIT No HighRisk Men CRP and CVD Mo d el RR fo r CRP (9 5 % CI) Cov ari ates1 1 .2 (1 .05 8 ) none2 1 .29 (1 .12 9 )g ende r, a g e, ce n ter , BMI ,s m o k e, m ed s3 1 .22 (1 .05 0 )p lus H T , DM,albu m inu ria4 1 .15 (0 .99 5 )p lus PAI1,fib ri n oge n • CRP high in populations with high rates of obesity and diabetes • CRP, the。