Di Carli Marcelo F, Afonso Luis, Campisi Roxana, Ramappa Preeti, Bianco-Batlles Daniela, Grunberger George, Schelbert Heinrich R
Department of Medicine, Wayne State University School of Medicine, Detroit, Mich, USA.
Am Heart J. 2002 Oct;144(4):711-8.
Diabetes mellitus abolishes the sex differential in coronary artery disease morbidity and mortality in premenopausal women. This finding is independent of other diabetes-associated risk factors, suggesting that other mechanisms such as impaired coronary vascular function may contribute to the increased cardiovascular risk in women with diabetes. The objective of this study was to investigate the effect of diabetes on coronary vascular function in premenopausal women.
We studied 13 premenopausal women with diabetes (aged 41 +/- 10 years) who were free of overt cardiovascular complications, and 21 control women (12 age-matched and 9 postmenopausal [aged 56 +/- 8 years]). We used [13N]-ammonia as the flow tracer and positron emission testing to measure myocardial blood flow (MBF) at rest, during maximal hyperemia, and in response to cold pressor testing.
Baseline MBF was lower in the postmenopausal controls, reflecting the differences in cardiac work and oxygen demand as assessed by the rate-pressure product. However, baseline MBFs were similar in the 3 groups after normalization for differences in the rate-pressure product. During hyperemia, MBF increased and coronary vascular resistance decreased significantly in the 3 groups. However, the increase (from baseline) in MBF in the women with diabetes (164% +/- 58%) was less than in the premenopausal controls (258% +/- 81%, P =.021), but not significantly different from the postmenopausal control women (204% +/- 104%, P =.51). Likewise, the increase in MBF in response to cold pressor testing in the women with diabetes (24% +/- 19%) was significantly lower than in the premenopausal controls (60% +/- 39%, P =.013), but similar to that in postmenopausal control women (27% +/- 15%, P =.97). These differences persisted after adjusting for age and diabetes-associated metabolic abnormalities.
These results demonstrate reduced coronary vasodilator function and impaired response of resistance vessels to increased sympathetic stimulation in premenopausal women with diabetes, similar to those observed in healthy postmenopausal women in whom the sex differential in coronary artery disease morbidity and mortality is no longer present.
糖尿病消除了绝经前女性冠心病发病率和死亡率的性别差异。这一发现独立于其他与糖尿病相关的危险因素，提示诸如冠状动脉血管功能受损等其他机制可能导致糖尿病女性心血管风险增加。本研究的目的是调查糖尿病对绝经前女性冠状动脉血管功能的影响。
我们研究了13名无明显心血管并发症的绝经前糖尿病女性（年龄41±10岁），以及21名对照女性（12名年龄匹配者和9名绝经后女性[年龄56±8岁]）。我们使用[13N] - 氨作为血流示踪剂，并通过正电子发射测试来测量静息、最大充血时以及冷加压测试时的心肌血流量（MBF）。
绝经后对照组的基线MBF较低，反映出通过心率 - 血压乘积评估的心脏做功和氧需求的差异。然而，在对心率 - 血压乘积差异进行标准化后，三组的基线MBF相似。在充血期间，三组的MBF均增加且冠状动脉血管阻力显著降低。然而，糖尿病女性的MBF（相对于基线）增加幅度（164%±58%）小于绝经前对照组（258%±81%，P = 0.021），但与绝经后对照女性（204%±104%，P = 0.51）无显著差异。同样，糖尿病女性在冷加压测试时MBF的增加幅度（24%±19%）显著低于绝经前对照组（60%±39%，P = 0.013），但与绝经后对照女性（27%±15%，P = 0.97）相似。在对年龄和与糖尿病相关的代谢异常进行校正后，这些差异仍然存在。
这些结果表明，绝经前糖尿病女性的冠状动脉舒张功能降低，阻力血管对交感神经刺激增加的反应受损，这与在冠心病发病率和死亡率不再存在性别差异的健康绝经后女性中观察到的情况相似。
