Effect of Long-Term Metformin and Lifestyle in the Diabetes Prevention Program and Its Outcome Study on Coronary Artery Calcium.
Effect of Long-Term Metformin and Lifestyle in the Diabetes Prevention Program and Its Outcome Study on Coronary Artery Calcium.
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DOI：
10.1161/circulationaha.116.025483
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发表时间：
2017-07-04
期刊：
影响因子：
37.8
通讯作者：
Diabetes Prevention Program Research Group
中科院分区：
文献类型：
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作者：
Goldberg RB;Aroda VR;Bluemke DA;Barrett-Connor E;Budoff M;Crandall JP;Dabelea D;Horton ES;Mather KJ;Orchard TJ;Schade D;Watson K;Temprosa M;Diabetes Prevention Program Research Group
尽管通过强化危险因素管理降低了冠心病（CHD）的发病率，但糖尿病和前驱糖尿病患者的CHD风险仍然增加。可能需要糖尿病预防干预来降低CHD风险。在糖尿病预防项目（DPP）及其结局研究（DPPOS）中对这种方法进行了检查，这是一项在3234例糖尿病前期受试者（平均[αSD]年龄64±10岁）中进行的长期干预研究，显示与安慰剂相比，生活方式和二甲双胍可降低3.2年的糖尿病风险。DPPOS为所有参与者提供定期的团体生活方式会议，并在最初随机分配的二甲双胍组中继续二甲双胍。在平均随访14年后，使用冠状动脉钙（CAC）测量对2029名参与者的亚临床动脉粥样硬化进行了评估。CAC评分作为CAC严重程度进行连续分析，并分类为CAC存在（CAC评分>0），并在男性和女性中分别报告。在生活方式和安慰剂干预组之间没有CAC差异，在任何性别中。二甲双胍组男性患者的CAC严重程度和存在率显著低于安慰剂组（年龄校正平均CAC严重程度：39.5 vs 66.9 Au，p=0.04; CAC存在率：75% vs 84%，p=0.02），但二甲双胍对女性患者无影响。在多变量分析中，二甲双胍在男性中的作用不受人口统计学、人体测量学或代谢因素、糖尿病发展或使用/不使用他汀类药物治疗的影响。二甲双胍可以预防男性糖尿病前期和早期糖尿病患者的冠状动脉粥样硬化。
Despite the reduced incidence of coronary heart disease (CHD) with intensive risk factor management, people with diabetes and prediabetes remain at increased CHD risk. Diabetes prevention interventions may be needed to reduce CHD risk. This approach was examined in the Diabetes Prevention Program (DPP) and its Outcome Study (DPPOS), a long-term intervention study in 3234 subjects with prediabetes (mean [αSD] age 64±10 yrs) which showed reduced diabetes risk with lifestyle and metformin compared to placebo over 3.2 years. The DPPOS offered periodic group lifestyle sessions to all participants and continued metformin in the originally randomized metformin group. Subclinical atherosclerosis was assessed in 2029 participants using coronary artery calcium (CAC) measurements after 14 years of average followup. The CAC scores were analyzed continuously as CAC severity, and categorically as CAC presence (CAC score>0), and reported separately in men and women. There were no CAC differences between lifestyle and placebo intervention groups, in either sex. CAC severity and presence were significantly lower among men in the metformin versus the placebo group (age-adjusted mean CAC severity: 39.5 vs 66.9 AU, p=0.04; CAC presence: 75% vs 84%, p=0.02), but no metformin effect was seen in women. In multivariate analysis, the metformin effect in men was not influenced by demographic, anthropometric or metabolic factors, by the development of diabetes, or by use/non-use of statin therapy. Metformin may protect against coronary atherosclerosis in prediabetes and early diabetes among men.