Determinants of progression of coronary artery calcification in type 2 diabetes
Determinants of progression of coronary artery calcification in type 2 diabetes
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DOI：
10.1016/j.jacc.2007.08.032
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发表时间：
2007-12-04
影响因子：
24
通讯作者：
Lahiri, Avijit
中科院分区：
文献类型：
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作者：
Anand, Dhakshinamurthy Vijay;Lim, Eric;Lahiri, Avijit
本研究前瞻性评价心血管危险因素、选定的生物标志物（高敏c反应蛋白[hs-CRP]、白细胞介素[IL]-6和骨保护素[OPG]）与2型糖尿病患者冠状动脉钙化（CAC）进展的关系。背景冠状动脉钙化是冠状动脉粥样硬化的典型症状。骨保护素是一种参与骨重塑的信号分子，涉及血管钙化和动脉粥样硬化的调节。方法对398例既往无冠状动脉疾病或症状的2型糖尿病患者（年龄52 +/- 8岁，61%为男性，糖化血红蛋白[HbA(1)c] 8 +/- 1.5）进行CAC影像学随访（平均随访2.5 +/- 0.4年）。CAC的进展/回归定义为基线和随访体积CAC评分的平方根转换值之间的变化：2.5。在基线和随访时测量人口统计学数据、危险因素、血糖控制、药物使用、血清hs-CRP、IL-6和血浆OPG水平。结果211例（53%）患者在基线时有CAC。118例（29.6%）患者出现CAC进展，3例（0.8%）患者出现退化。年龄、男性、高血压、基线CAC、HbA(1)c bbb70、腰臀比、IL-6、OPG、使用β受体阻滞剂、钙通道拮抗剂、anglotenins转换酶（ACE）抑制剂、他汀类药物和Framingham/UKPDS（英国前瞻性糖尿病研究）风险评分是CAC进展的单变量预测因子。在多变量模型中，基线CAC (CAC > 400的比值比[OR] = 6.38, 95%可信区间（CI] 2.63 ~ 15.5, p < 0.001）、HbAc > 7 （OR 1.95, Cl 1.08 ~ 3.52, p 0.03）和他汀类药物使用（OR 2.27, Cl 1.38 ~ 3.73, p = 0.001）是CAC进展的独立预测因子。结论基线CAC严重程度和血糖控制不佳是2型糖尿病患者CAC进展的重要危险因素。
Objectives This study prospectively evaluated the relationship between cardiovascular risk factors, selected biomarkers (high-sensitivity C-reactive protein [hs-CRP], interleukin [IL]-6, and osteoprotegerin [OPG]), and the progression of coronary artery calcification (CAC) in type 2 diabetic subjects.Background Coronary artery calcification is pathognomonic of coronary atherosclerosis. Osteoprotegerin is a signaling molecule involved in bone remodeling that has been implicated in the regulation of vascular calcification and atherogenesis.Methods Three hundred ninety-eight type 2 diabetic subjects without prior coronary disease or symptoms (age 52 +/- 8 years, 61% male, glycated hemoglobin [HbA(1)c] 8 +/- 1.5) were evaluated serially by CAC imaging (mean follow-up 2.5 +/- 0.4 years). Progression/regression of CAC was defined as a change :2.5 between the square root transformed values of baseline and follow-up volumetric CAC scores. Demographic data, risk factors, glycemic control, medication use, serum hs-CRP, IL-6, and plasma OPG levels were measured at baseline and follow-up.Results Two hundred eleven patients (53%) had CAC at baseline. One hundred eighteen patients (29.6%) had CAC progression, whereas 3 patients (0.8%) had regression. Age, male gender, hypertension, baseline CAC, HbA(1)c > 7, waist-hip ratio, IL-6, OPG, use of beta-blockers, calcium channel antagonists, anglotensin-converting enzyme (ACE) inhibitors, statins, and Framingham/UKPDS (United Kingdom Prospective Diabetes Study) risk scores were univariable predictors of CAC progression. In the multivariate model, baseline CAC (odds ratio [OR) for CAC > 400 = 6.38, 95% confidence interval (CI] 2.63 to 15.5, p < 0.001), HbAc > 7 (OR 1.95, Cl 1.08 to 3.52, p 0.03), and statin use (OR 2.27, Cl 1.38 to 3.73, p = 0.001) were independent predictors of CAC progression.Conclusions Baseline CAC severity and suboptimal glycemic control are strong risk factors for CAC progression in type 2 diabetic subjects.