Association of angiotensin-converting enzyme inhibitor therapy and comorbidity in diabetes: results from the Vermont diabetes information system.
Association of angiotensin-converting enzyme inhibitor therapy and comorbidity in diabetes: results from the Vermont diabetes information system.
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DOI：
10.1186/1472-6823-8-17
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发表时间：
2008-12-05
影响因子：
2.7
通讯作者：
Littenberg B
中科院分区：
文献类型：
--
作者：
Ramos-Nino ME;Maclean CD;Littenberg B
血管紧张素转换酶抑制剂（ACE抑制剂）通过阻断血管紧张素转换酶（ACE）降低外周血管阻力。ACE抑制剂通常用于治疗充血性心力衰竭和高血压，但也有其他效果的报道。在这项研究中，我们探讨了ACE抑制剂治疗与成人糖尿病合并症患病率之间的关系。我们从社区实践中随机选择了1003名成人糖尿病患者。患者在家中接受访谈，并自我报告他们的个人和临床特征，包括合并症。目前的药物是通过直接观察药物容器获得的。我们建立了logistic回归模型，以合并症的历史作为结果变量，目前ACE抑制剂的使用作为主要预测变量。我们调整了社会因素（年龄、性别、饮酒、吸烟）和临床因素（收缩压、体重指数（BMI）、糖化血红蛋白（A1C）、合并症数量和处方药数量）可能造成的混淆。ACE使用者报告任何癌症病史（不危及生命的皮肤癌除外）的频率低于非使用者（10% vs 15%；奇数比= 0.59；95%可信区间[0.39,0.89];P = 0.01）；有胃溃疡或消化性溃疡病史的患者少于非吸毒者（12% vs. 16%，奇比= 0.70,[0.49,1.01],P = 0.06）。校正潜在混杂因素后，ACE抑制剂与个人癌症史（比值比= 0.59,[0.39,0.89];P = 0.01）和消化性溃疡疾病（比值比= 0.68,[0.46,1.00],P = 0.05）呈显著负相关。ACE抑制剂的使用与糖尿病患者患癌症和消化性溃疡的可能性较低有关。这些发现受到横断面研究设计、合并症诊断的自我报告以及缺乏ACE抑制剂使用时间和持续时间信息的限制。需要进一步的研究来证实这些关联并了解其机制。
Angiotensin converting enzyme inhibitors (ACE inhibitors) reduce peripheral vascular resistance via blockage of angiotensin converting enzyme (ACE). ACE inhibitors are commonly used to treat congestive heart failure and high blood pressure, but other effects have been reported. In this study, we explored the association between ACE inhibitor therapy and the prevalence of comorbid conditions in adults with diabetes We surveyed 1003 adults with diabetes randomly selected from community practices. Patients were interviewed at home and self-reported their personal and clinical characteristics including comorbidity. Current medications were obtained by direct observation of medication containers. We built logistic regression models with the history of comorbidities as the outcome variable and the current use of ACE inhibitors as the primary predictor variable. We adjusted for possible confounding by social (age, sex, alcohol drinking, cigarette smoking) and clinical factors (systolic blood pressure, body mass index (BMI), glycosolated hemoglobin (A1C), number of comorbid conditions, and number of prescription medications). ACE users reported a history of any cancer (except the non-life-threatening skin cancers) less frequently than non-users (10% vs. 15%; odd ratio = 0.59; 95% confidence interval [0.39, 0.89]; P = 0.01); and a history of stomach ulcers or peptic ulcer disease less frequently than non-users (12% vs. 16%, odd ratio = 0.70, [0.49, 1.01], P = 0.06). After correcting for potential confounders, ACE inhibitors remained significantly inversely associated with a personal history of cancer (odds ratio = 0.59, [0.39, 0.89]; P = 0.01) and peptic ulcer disease (odd ratio = 0.68, [0.46, 1.00], P = 0.05). ACE inhibitor use is associated with a lower likelihood of a history of cancer and peptic ulcers in patients with diabetes. These findings are limited by the cross sectional study design, self-report of comorbid diagnoses, and lack of information on the timing and duration of ACE inhibitor use. Further research is needed to confirm these associations and understand their mechanisms.