Lower physical activity is a strong predictor of cardiovascular events in elderly patients with type 2 diabetes mellitus beyond traditional risk factors: The Japanese elderly diabetes intervention trial
Lower physical activity is a strong predictor of cardiovascular events in elderly patients with type 2 diabetes mellitus beyond traditional risk factors: The Japanese elderly diabetes intervention trial
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DOI：
10.1111/j.1447-0594.2011.00815.x
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发表时间：
2012-04-01
影响因子：
3.3
通讯作者：
Ito, Hideki
中科院分区：
文献类型：
--
作者：
Iijima, Katsuya;Iimuro, Satoshi;Ito, Hideki
目的：众所周知，体力活动的减少与生活方式相关的疾病，包括心血管（CV）事件有关。然而，对于老年患者体力活动与心血管事件之间的相关性知之甚少，因为最近积累的报告主要涉及中年人群。在这项研究中，我们调查了体力活动和心血管事件之间的相关性，在日本老年2型糖尿病（T2 DM）患者。方法：共938例日本老年T2 DM患者（447名男性和491名女性，平均年龄71.9岁）参加（2000-2002年）在日本老年糖尿病干预试验（J-EDIT）在这项研究中使用。身体活动包括三个组成部分，工作，运动和休闲时间，他们的生活方式进行了评估，使用Baecke问卷在基线。结果：在65.2个月的随访期内，共发生165起事件和71例死亡。TAS分级越高，所有事件的风险越低（Q2、Q3和Q4的风险比分别为0.82、0.77和0.54），具有统计学显著性。即使在对协变量进行多变量校正后，较高的TAS等级也是所有事件的强预测因子，TAS对脑血管事件的预测比对心脏事件的预测更有效。与此相反，全因死亡率随着TAS分级逐渐降低;在TAS的四个等级中，在整个随访期间，脂糖代谢、血压、体格测量、认知功能和抑郁量表等多个参数均无显著变化，结论：较低的体力活动量是老年T2 DM患者所有心血管事件的一个强而独立的预测因子，超过了传统的危险因素。除了严格管理每个动脉粥样硬化风险因素外，在临床实践中，与患者接触以增加和维持其生活方式中的体力活动水平也是必不可少的。Geriatr Gerontol Int 2012; 12（Suppl. 1）：77-87.
Aim: It is well known that a decline in physical activity is associated with lifestyle-related diseases including cardiovascular (CV) events. However, little is known about the association between physical activity and CV events in elderly patients, because recent accumulating reports have mainly dealt with middle-aged populations. In this study, we investigated the correlation between physical activity and CV events in Japanese elderly patients with type 2 diabetes mellitus (T2DM).Methods: A total of 938 Japanese elderly patients with T2DM (447 men and 491 women, mean age 71.9 years) enrolled (2000-2002) in the Japanese Elderly Diabetes Intervention Trial (J-EDIT) were used in this study. Physical activity consisting of three components, work, sports and leisure-time, of their lifestyle was evaluated using the Baecke questionnaire at baseline. Total activity score (TAS) as a sum of each activity score was divided into four quartiles (Q1 to Q4).Results: During a follow-up period of 65.2 months, 165 events and 71 deaths in total occurred. Higher TAS grade was associated with reduced risk of all events (hazard ratios: 0.82, 0.77 and 0.54 in Q2, Q3 and Q4, respectively) with statistical significance. Even after multivariate adjustment for covariates, higher TAS grade was a strong predictor of all events, and the prediction by TAS of cerebrovascular events was more effective than that of cardiac events. In contrast, all-cause mortality gradually decreased according to TAS grade; however, no statistical significance was found. Among the four grades of TAS, no significant change in several parameters, such as profiles of lipid and glucose metabolism, blood pressure, physical measurements, cognitive function and depression scale, was found throughout the follow-up period, suggesting that the higher level of physical activity itself was associated with the risk reduction of primary events.Conclusion: Lower physical activity is a strong and independent predictor of all CV events in the elderly with T2DM beyond traditional risk factors. In addition to strict management of each atherosclerotic risk factor, engagement with patients to augment and maintain the level of physical activity in their lifestyle is also essential in clinical practice. Geriatr Gerontol Int 2012; 12 (Suppl. 1): 77-87.