Progression of Electrocardiographic Abnormalities in Type 1 Diabetes During 16 Years of Follow-up: The Epidemiology of Diabetes Interventions and Complications (EDIC) Study.
Progression of Electrocardiographic Abnormalities in Type 1 Diabetes During 16 Years of Follow-up: The Epidemiology of Diabetes Interventions and Complications (EDIC) Study.
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16 年随访期间 1 型糖尿病心电图异常的进展：糖尿病干预和并发症 (EDIC) 研究的流行病学。
DOI：
10.1161/jaha.115.002882
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发表时间：
2016
影响因子：
5.4
通讯作者：
DCCT/EDICResearchGroup
中科院分区：
文献类型：
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作者：
Soliman,ElsayedZ;Backlund,Jye-YuC;Bebu,Ionut;Li,Yabing;Zhang,Zhu-Ming;Cleary,PatriciaA;Lachin,JohnM;DCCT/EDICResearchGroup
研究背景心电图是心血管疾病(CVD)风险评估的客观工具。方法和结果我们从糖尿病干预和并发症流行病学(EDIC)研究中评估了1314例1型糖尿病(T1D)患者的心电图异常分布和发生新异常的危险因素。一年一度的心电图被集中阅读。根据明尼苏达心电图分类，将心电图异常分为重大和轻微两类。在EDIC第一年(基线)，356名参与者(27.1%)至少有一项心电图异常(主要或轻微)，而26名(2%)至少有一项重大异常。在16年的随访中，1016名(77.3%)的参与者至少出现了一种新的心电图异常(重大或轻微)，而172名(13.1%)的参与者至少发生了一种新的重大异常。发生新的主要心电图异常的独立危险因素有：年龄、当前吸烟、收缩压升高和糖化血红蛋白升高(危险比[HR][95%CI]：每1年增加1.04[1.02-1.06]，每1 mm汞增加1.75[1.22-2.53]，1.03[1.01-1.05]，每10%增加1.16[1.04-1.29])。发生新的心电图异常(主要或轻微)的独立危险因素是年龄和收缩压(HR[95%CI]：每1年上升1.02[1.01~1.03]，每1 mm汞上升1.01[1.00~1.02])。结论新的心电图异常通常发生在T1D病程中，与公认的随着年龄增加心血管疾病的风险增加相一致。高龄、收缩压升高、吸烟和HbA1c升高是发生主要心电图异常的独立危险因素，这强调了在管理常见的心血管危险因素的同时，严格控制血糖对T1D的重要性。
BackgroundThe electrocardiogram (ECG) is an objective tool for cardiovascular disease (CVD) risk assessment.Methods and ResultsWe evaluated distribution of ECG abnormalities and risk factors for developing new abnormalities in 1314 patients with type 1 diabetes (T1D) from the Epidemiology of Diabetes Interventions and Complications (EDIC) study. Annual ECGs were centrally read. ECG abnormalities were classified as major and minor according to the Minnesota ECG Classification. At EDIC year 1 (baseline), 356 (27.1%) of the participants had at least 1 ECG abnormality (major or minor) whereas 26 (2%) had at least one major abnormality. During 16 years of follow‐up, 1016 (77.3%) participants developed at least 1 new ECG abnormality (major or minor), whereas 172 (13.1%) developed at least 1 new major abnormality. Independent risk factors for developing new major ECG abnormalities were: age, current smoking, increased systolic blood pressure, and higher glycosylated hemoglobin (hazard ratio [HR] [95% CI]: 1.04 [1.02–1.06] per 1‐year increase, 1.75 [1.22–2.53], 1.03 [1.01–1.05] per 1 mm Hg increase, and 1.16 [1.04–1.29] per 10% increase, respectively). Independent risk factors for developing any new ECG abnormalities (major or minor) were age and systolic blood pressure (HR [95% CI]: 1.02 [1.01–1.03] per 1‐year increase and 1.01 [1.00–1.02] per 1 mm Hg increase, respectively).ConclusionsNew ECG abnormalities commonly occur in the course of T1D, consistent with the recognized increasing risk for CVD as patients age. Advanced age, increased systolic blood pressure, smoking, and higher HbA1c are independent risk factor for developing major ECG abnormalities, which underscores the importance of tight glucose control in T1D in addition to management of common CVD risk factors.