ABSTRACT
Objectives To investigate the relationship between albuminuria and all-cause mortality and cardiovascular mortality in middle-to-old-aged Chinese population. Methods A total of 2500 residents aged more than 40 years old were selected using random cluster sampling in Shougang community, Beijing, and 2315 of them took part in the survey finally. Morning urinary samples were collected. Urinary albumin and creatinine were measured. Albumin to creatinine ratio (ACR) was calculated and used as an index of albuminuria. The subjects were grouped according to ACR: normoalbuminuria (NO, ACR＜ 30 mg/g), microalbuminuria (MI, ACR 30-299 mg/g), and macroalbuminuria (MA, ACR ≥ 300 mg/g). Albuminuria (AL) group consisted of MI group and MA group. Cardiovascular risk factors were also investigated. Then all-cause mortality and cardiovascular mortality were collected after 4 years. The Cox model was used to analyze the relationship between albuminuria and all-cause mortality after adjusting for confounders. Results The prevalence of microalbuminuria and macroalbuminuria was 7.6% and 1.4% respectively. After 4 years follow-up,the cardiovascular mortality was 2.7/1000 person-years in NO group, 19.9/1000 person-years in MI group, and 11.5/1000 person-years in MA group and the all-cause mortality was 6.6/1000,25.9/1000 and 57.5/1000 person-years respectively. After adjusting for age, gender, smoking, body mass index, serum lipids, hypertension, diabetes mellitus, cardiovascular disease at baseline and serum creatinine, the hazard ratio (HR) of cardiovascular mortality in AL group was 5.26 [95% confidence intervals (CI) 2.26-12.24] compared with NO group; the HR of all-cause mortality was 3.34 (95% CI 1.82-6.15). Among patients without cardiovascular disease at baseline, the corresponding HRs were 6.92 (95%CI 1.80-26.58) and 2.85 (95%CI 1.22-6.65) respectively.Conclusion In the population studied, albuminuria is an independent risk factor for all-cause mortality and cardiovascular mortality.
ABSTRACT
Objective To investigate the outcome and related risk factors of integrated intensive intervention in participants with impaired glucose regulation (IGR) after two years by the criteria of American Diabetes Association 2003. Methods The subjects who remained to be IGR at the end of first year following 75 g oral glucose tolerance test were randomly assigned to either a routine care control group or to an intensive integrated intervention group. The control group received general dietary and exercise advice at baseline and was followed up. In addition to dietary control and exercise advice, mefformin or acarbose were administrated in the intervention group. The latter group was also advised to take antihypertensive agents, lipid-regulating agents if necessary, as well as aspirin. Results The proportion of patients who fulfilled the assigned goals of blood glucose, blood pressure, body mass index or triglycerides was significantly higher in the intensive group than those in the control group. None in the intensive group developed overt diabetes mellitus, while 8 (9.3%) in the control group did. The proportion of patients who reverted to normal glucose tolerance (NGT) was slightly higher in the intensive group than in the control group (29.5% vs 22.1%, P>0.05). Logistic analysis showed that increase of waist circumference and systolic blood pressure was positively while the improvement of islet β-cell function was negatively correlated with the development of diabetes mellitus. Conclusions The intensive integrated intervention could significantly decrease the conversion rate of IGR to diabetes mellitus, and increase the chance of reversion to NGT. The increase of waist circumference or systolic blood pressure, the deterioration of islet β-ccll function were the influencing factors of the conversion of IGR to diabetes mellitus.
ABSTRACT
Objective To investigate the appropriate waist circumference (WC) cutoff points for central obesity in the middle-aged and elderly Beijing residents by the metabolic syndrome definition of the International Diabetes Federation (IDF). Methods A total of 2,344Beijing residents aged ≥40 years were investigated. They answered questionnaires, received physical examinations, and underwent plasma glucose and lipid profile measurement. Those non-diabetic subjects underwent a 75g oral glucose tolerance test. All data were analyzed to calculate the appropriate WC cutoff points for central obesity reaching the diagonsis of MS. Results 1) Both in males and females, the triglyceride (TG), systolic blood pressure, diastolic blood pressure and fasting plasma glucose (FPG) increased linearly with WC, and the high density lipoprotein cholesterol (HDL-C) decreased linearly with WC (P＜0.05). 2)The prevalence of elevated TG,reduced HDL-C, elevated blood pressure, elevated FBG, or ≥ 2 of these factors increased with WC (P＜0.05). 3) Based on the receiver operating characteristic (ROC) curve analysis and Youden index, the WC values for central obesity and for detecting BMI ≥ 25 kg/m2were about 90 cm for men and 80 cm for women. 4) The odds ratio for the presence of two or more metabolic risk factors increased abruptly in men with WC ≥ 90 cm and in women with WC ≥ 80 cm. Conclusions The appropriate WC cutoff point for central obesity was determined to be 90 cm for men and 80 cm for women in the middle-aged and elderly Beijing residents by the metabolic syndrome definition of IDF.