缺血性心脏病非糖尿病患者空腹血糖浓度受损：预后较差的一个标志物。

Impaired fasting glucose concentrations in nondiabetic patients with ischemic heart disease: a marker for a worse prognosis.

作者信息

Fisman E Z, Motro M, Tenenbaum A, Boyko V, Mandelzweig L, Behar S

机构信息

Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, 526521 Tel-Hashomer, Israel.

出版信息

Am Heart J. 2001 Mar;141(3):485-90. doi: 10.1067/mhj.2001.113219.

DOI:10.1067/mhj.2001.113219

PMID:11231448

Abstract

BACKGROUND

The issue of whether glucose concentrations below the diabetic threshold may be predictive of increased cardiovascular risk has not yet been fully elucidated. The current study evaluates the prognosis of nondiabetic patients with ischemic heart disease (IHD) and impaired fasting glucose (IFG) over a 7.7-year follow-up period.

METHODS

A total of 11,853 patients with documented coronary artery disease aged between 45 and 74 years were examined. Patients were divided into 3 groups on the basis of their fasting blood glucose levels at screening: nondiabetic individuals, patients with IFG, and undiagnosed diabetic patients. Patients who were on any type of pharmacologic antidiabetic treatment were excluded from the study. Mortality rates were assessed separately for each group.

RESULTS

The population comprised 9773 nondiabetic patients (82.4%, glucose up to 109 mg/dL), 1258 patients with IFG levels (10.6%, glucose 110-125 mg/dL), and 822 diabetic subjects (7%, glucose > or =126 mg/dL). Patients were followed up from 6.2 to 9.0 years (mean follow-up period 7.7 +/- 1.5 years). Crude mortality was lower in the nondiabetic subjects than in the 2 other groups. All-cause mortality in the nondiabetic group was 14.3% compared to 20.1% in patients with IFG and 24.3% in the undiagnosed (P <.001). Multivariate adjustment showed the lowest mortality in nondiabetic subjects, who exhibited a survival rate of 0.86 at the end of the follow-up, whereas the lowest survival-0.75-was seen among undiagnosed diabetic patients (P =.0001). An intermediate value of 0.78 was documented for patients with IFG (P <.01). After multivariate analysis, with nondiabetic patients as the reference group, IFG was identified as a consistent predictor of increased all-cause and IHD mortality with hazard ratios of 1.39 (95% confidence interval 1.21-1.59) and 1.29 (95% confidence interval 1.01-1.64), respectively.

CONCLUSIONS

The main finding of this study is the substantially increased mortality rate among nondiabetic coronary patients with IFG, who had fasting glucose levels markedly lower than hitherto acknowledged as defining overt diabetes.

摘要

背景

血糖浓度低于糖尿病阈值是否可预测心血管风险增加这一问题尚未完全阐明。本研究评估了非糖尿病缺血性心脏病（IHD）和空腹血糖受损（IFG）患者在7.7年随访期内的预后情况。

方法

共检查了11853例年龄在45至74岁之间有冠状动脉疾病记录的患者。根据筛查时的空腹血糖水平将患者分为3组：非糖尿病个体、IFG患者和未确诊的糖尿病患者。正在接受任何类型药物抗糖尿病治疗的患者被排除在研究之外。分别评估每组的死亡率。

结果

该人群包括9773例非糖尿病患者（82.4%，血糖高达109mg/dL）、1258例IFG水平患者（10.6%，血糖110 - 125mg/dL）和822例糖尿病患者（7%，血糖≥126mg/dL）。患者随访时间为6.2至9.0年（平均随访期7.7±1.5年）。非糖尿病患者的粗死亡率低于其他两组。非糖尿病组的全因死亡率为14.3%，而IFG患者为20.1%，未确诊患者为24.3%（P<.001）。多变量调整显示非糖尿病患者死亡率最低，随访结束时生存率为0.86，而未确诊糖尿病患者生存率最低，为0.75（P = 0.0001）。IFG患者记录的中间值为0.78（P<.01）。多变量分析后，以非糖尿病患者作为参照组，IFG被确定为全因死亡率和IHD死亡率增加的一致预测因素，风险比分别为1.39（95%置信区间1.21 - 1.59）和1.29（95%置信区间1.01 - 1.64）。