Carotid Plaque Calcification Predicts Future Cardiovascular Events in Type 2 Diabetes
Carotid Plaque Calcification Predicts Future Cardiovascular Events in Type 2 Diabetes
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DOI：
10.2337/dc15-0327
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发表时间：
2015-10-01
期刊：
影响因子：
16.2
通讯作者：
Avogaro, Angelo
中科院分区：
文献类型：
--
作者：
de Kreutzenberg, Saula Vigili;Fadini, Gian Paolo;Avogaro, Angelo
颈动脉斑块的存在与未来的心血管事件有关，局部斑块成分是一个独立的预后预测因子。我们研究了超声检查确定的颈动脉斑块钙化和2型糖尿病（T2 D）的主要不良心血管事件（MACE）和死亡之间的关联。研究设计和方法我们纳入了581例接受常规颈动脉超声检查的T2 D患者。斑块分为回声（富含脂质）、异质性和回声（钙化）。我们收集了基线时的人口统计学、人体测量学和临床数据，并对患者进行了长达9年的随访。在81.8%的患者中检测到TSPLAQUES（回声型16.4%，异质型43.2%，回声型22.2%）。在随访期间（4.3 0.1年），发生了58例死亡（27例心血管）和236例致死性和非致死性MACE。在单变量分析中，存在或不存在任何颈动脉斑块与发生MACE相关，风险比（95%CI）从回声斑块（1.97 [0.93-3.44]）到异质斑块（3.10 [2.09-4.23]）再到回声斑块（3.71 [2.09-5.59]）逐渐增加。与回声斑块相比，回声斑块与MACE事件相关，与混杂因素无关。这种关联在调整狭窄程度后减弱，但在狭窄30%的患者中，回声斑块类型仍然预测总的和动脉粥样硬化的MACE，即使在进一步调整平均intima-media thickness.CONCLUSIONSIn T2 D，颈动脉斑块钙化预测MACE，特别是在狭窄程度较低的患者中。糖尿病动脉粥样硬化钙化的生物学需要进一步阐明，以了解这种关联的基础。
OBJECTIVEThe presence of carotid plaques is associated with future cardiovascular events, with local plaque composition being an independent outcome predictor. We examined the association between ultrasonographically determined carotid plaque calcification and incident major adverse cardiovascular events (MACE) and death in type 2 diabetes (T2D).RESEARCH DESIGN AND METHODSWe enrolled 581 patients with T2D who underwent routine carotid ultrasonography. Plaques were classified as echolucent (lipid rich), heterogenous, and echogenic (calcific). We collected demographic, anthropometric, and clinical data at baseline and followed the patients for up to 9 years.RESULTSPlaques were detected in 81.8% of the patients (echolucent in 16.4%, heterogenous in 43.2%, and echogenic in 22.2%). During follow-up (4.3 0.1 years), 58 deaths (27 cardiovascular) and 236 fatal and nonfatal MACE occurred. In univariate analyses, presence versus absence of any carotid plaque was associated with incident MACE, and the hazard ratio (95% CI) progressively increased from echolucent (1.97 [0.93-3.44]), to heterogeneous (3.10 [2.09-4.23]), to echogenic (3.71 [2.09-5.59]) plaques. Compared with echolucent plaques, echogenic plaques were associated with incident MACE independently from confounders. This association was attenuated after adjusting for the degree of stenosis, but in patients with stenosis 30%, echogenic plaque type still predicted total and atherosclerotic MACE, even after further adjusting for mean intima-media thickness.CONCLUSIONSIn T2D, carotid plaque calcification predicts MACE, especially in patients with a low degree of stenosis. The biology of atherosclerotic calcification in diabetes needs to be further elucidated to understand the basis of this association.