Diabetic Med：高血压患者治疗时HDL低预示新发糖尿病风险更高

　　既往研究表明，基线高密度脂蛋白胆固醇（HDL-C）水平较低的高血压患者发生糖尿病的风险增加。美国纽约威尔康奈尔医学院Peter M. Okin等开展的一项研究表明，与基线HDL-C水平较低者相比，治疗期间HDL-C水平仍较低者新发糖尿病的风险更大。（Diabetic Med. 2013年4月16日在线版）

　　该研究纳入7485例无糖尿病史的高血压患者，平均随访4.7年。520例患者发生糖尿病。单变量Cox分析表明，与HDL-C水平处于最高四分位（>1.78 mmol/L）者相比，基线和治疗期间HDL-C水平处于最低四分位（<1.21 mmol/L）者新发糖尿病的风险分别增加4倍和8倍以上，其余患者发生糖尿病的风险相对较低。多因素Cox分析显示，治疗期间HDL-C水平处于最低四分位者罹患糖尿病的风险约为HDL-C水平最高者的9倍（HR=8.7），而基线HDL-C水平<1.21 mmol/L者发生糖尿病的风险低得多（HR=3.9）。

与糖尿病相关的拓展阅读：

• Diabetes Care：良好的血糖和血压控制有益于延长糖尿病患者生存期
• 第一时相胰岛素分泌减少是我国2型糖尿病关键诱因
• AACE2013糖尿病治疗方案
• 美国糖尿病防治十年进展回顾
• NEJM：糖尿病治疗有进展但仍存不足 更多信息请点击：有关糖尿病更多资讯

In-treatment HDL cholesterol levels and development of new diabetes mellitus in hypertensive patients: The LIFE Study
Aims
Although hypertensive patients with low baseline HDL cholesterol levels have a higher incidence of diabetes mellitus, whether changing levels of HDL over time are more strongly related to the risk of new diabetes in hypertensive patients has not been examined.
Methods
Incident diabetes mellitus was examined in relation to baseline and in-treatment HDL levels in 7485 hypertensive patients with no history of diabetes randomly assigned to losartan- or atenolol-based treatment.
Results
During 4.7 ± 1.2 years follow-up, 520 patients (6.9%) developed new diabetes. In univariate Cox analyses, compared with the highest quartile of HDL levels (> 1.78 mmol/l), baseline and in-treatment HDL in the lowest quartile (< 1.21 mmol/l) identified patients with > 5-fold and > 9 fold higher risks of new diabetes, respectively; patients with baseline or in-treatment HDL in the 2nd and 3rd quartiles had intermediate risk of diabetes. In multivariable Cox analyses, adjusting for randomized treatment, age, sex, race, prior anti-hypertensive therapy, baseline uric acid, serum creatinine and glucose entered as standard covariates, and in-treatment non-HDL cholesterol, Cornell product left ventricular hypertrophy, diastolic and systolic pressure, BMI, hydrochlorothiazide and statin use as time-varying covariates, the lowest quartile of in-treatment HDL remained associated with a nearly 9-fold increased risk of new diabetes (hazard ratio 8.7, 95% CI 5.0–15.2), whereas the risk of new diabetes was significantly attenuated for baseline HDL < 1.21 mmol/l (hazard ratio 3.9, 95% CI 2.8–5.4).
Conclusions
Lower in-treatment HDL is more strongly associated with increased risk of new diabetes than baseline HDL level.