Manske C L, Wilson R F, Wang Y, Thomas W
Department of Medicine, University of Minnesota School of Medicine, Minneapolis.
Arch Intern Med. 1992 Dec;152(12):2450-5.
BACKGROUND--Thirty-five percent of type I-diabetic patients are dead of coronary artery disease by age 55 years, and the risk of death is increased eightfold to 15-fold in patients with nephropathy. However, the prevalence of coronary artery disease with respect to age is unknown and few risk factors have been identified. METHODS--One hundred ten insulin-dependent diabetic patients underwent routine pretransplant coronary angiography and cardiac risk factor assessment. Angiograms were evaluated by two angiographers for presence or absence of coronary artery disease (CAD, defined as one or more coronary artery stenoses of 50% or greater in diameter, and no CAD, defined as no stenosis of 25% or greater in diameter, respectively). Prevalence of CAD by age was determined, and associated risk factors were defined. RESULTS--Fifty-two of 110 patients had CAD. Coronary artery disease prevalence increased significantly with age; 13 of 16 patients older than 45 years of age had CAD. For patients 35 years of age or younger, associated risk factors included a family history of premature myocardial infarction, higher hemoglobin A1c level, hypertension for more than 5 years, lower high-density lipoprotein level, and smoking for more than 5 pack-years. For patients between 35 and 45 years of age, associated risk factors included number of years of diabetes, higher hemoglobin A1c levels, and smoking more than 5 pack-years. CONCLUSIONS--In type I-diabetic patients with nephropathy, CAD prevalence increased significantly with age and was found in the majority of patients older than 45 years of age. Coronary artery disease risk factors operative in the general population were significantly associated with CAD in this high-risk group. In addition, a role for hyperglycemia in accelerated atherogenesis was supported by the association of both higher hemoglobin A1c levels and number of years of diabetes with CAD.
背景——35%的1型糖尿病患者在55岁时死于冠状动脉疾病，而肾病患者的死亡风险增加8至15倍。然而，冠状动脉疾病的年龄患病率尚不清楚，且几乎未确定相关危险因素。
方法——110例胰岛素依赖型糖尿病患者接受了常规移植前冠状动脉造影和心脏危险因素评估。两位血管造影师对血管造影进行评估，以确定是否存在冠状动脉疾病（CAD，定义为一条或多条冠状动脉直径狭窄50%或以上，无CAD定义为直径狭窄25%或以上）。确定CAD的年龄患病率，并确定相关危险因素。
结果——110例患者中有52例患有CAD。冠状动脉疾病患病率随年龄显著增加；45岁以上的16例患者中有13例患有CAD。对于35岁及以下的患者，相关危险因素包括早发心肌梗死家族史、较高的糖化血红蛋白水平、高血压病史超过5年、较低的高密度脂蛋白水平以及吸烟史超过5包年。对于35至45岁的患者，相关危险因素包括糖尿病病程、较高的糖化血红蛋白水平以及吸烟史超过5包年。
结论——在患有肾病的1型糖尿病患者中，CAD患病率随年龄显著增加，且在大多数45岁以上的患者中存在。在这一高危人群中，普通人群中起作用的冠状动脉疾病危险因素与CAD显著相关。此外，较高的糖化血红蛋白水平和糖尿病病程与CAD的关联支持了高血糖在加速动脉粥样硬化中的作用。
