Diabetes and progression of coronary calcium under the influence of statin therapy
Diabetes and progression of coronary calcium under the influence of statin therapy
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DOI：
10.1016/j.ahj.2004.07.034
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发表时间：
2005-04-01
影响因子：
4.8
通讯作者：
Blumenthal, RS
中科院分区：
文献类型：
--
作者：
Budoff, MJ;Yu, D;Blumenthal, RS
背景冠状动脉钙（CAC）是检测冠心病（CHD）的敏感标志物。冠状动脉钙化可以用电子束断层扫描（EBT）精确量化。我们试图评估无症状2型糖尿病患者动脉粥样硬化的进展，并测量他汀类药物治疗对CAC进展的影响。方法对163例无症状2型糖尿病患者（男性120例，女性43例）进行评估。患者由医生转诊，并接受两次连续EBT扫描，间隔至少1年。收集了人口统计数据、冠心病危险因素和药物使用情况。排除有症状或已知冠心病的患者。结果患者平均年龄65 ~ 10岁。基线时平均CAC评分为651 +/- 414。163名参与者中只有9人（6%）的基线得分为0分。扫描间隔时间平均为27 +/- 15个月。未接受他汀类药物治疗的患者CAC进展的年平均增幅为20%(4%-44%)，而接受他汀类药物治疗的患者CAC进展的年平均增幅为10% (4%-25%)（P = 0.0001）。血红蛋白A（1c）与CAC进展弱相关。结论无症状糖尿病患者冠状动脉钙化发生率高，动脉粥样硬化发生率高。他汀类药物治疗可使CAC的进展率降低50%。由于CAC的快速进展与冠状动脉事件有关，EBT可以作为一种无创的方法来跟踪动脉粥样硬化和治疗反应。
Background Coronary artery calcium (CAC) is a sensitive marker for the detection of coronary heart disease (CHD). Coronary artery calcification can be accurately quantified using electron beam tomography (EBT). We sought to evaluate the progression of atherosclerosis in asymptomatic persons with type 2 diabetes and measure the influence of statin therapy on CAC progression.Methods We evaluated 163 asymptomatic patients with type 2 diabetes (120 men, 43 women). Patients were physician referred and underwent 2 consecutive EBT scans at least 1 year apart. Demographic data, risk factors for CHD, and medication use were collected. Patients with symptoms or known CHD were excluded.Results The mean age was 65 10 years. The mean CAC score at baseline was 651 +/- 414. Only 9 (6%) of 163 of participants had scores of 0 at baseline. The time between scans averaged 27 +/- 15 months. Patients not treated with statins demonstrated a median annual increase in CAC progression of 20% (4%-44%), whereas statin-treated patients demonstrated increase of 10% (4%-25%) (P =.0001). Hemoglobin A(1c) was weakly associated with CAC progression.Conclusions Asymptomatic diabetic patients show a high prevalence of atherosclerosis based on high frequency of coronary calcification. Statin therapy induced a 50% reduction in the rate of CAC progression. As rapid CAC progression has been associated with coronary events, EBT may serve as a noninvasive method for following atherosclerosis and response to therapy.