Espinola-Klein C, Rupprecht H-J, Blankenberg S, Bickel C, Fossmeyer U, Kopp H, Victor A, Peetz D, Lackner K
II. Medizinische Klinik und Poliklinik, Johannes-Gutenberg-Universität Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
Z Kardiol. 2004;93 Suppl 4:IV48-55. doi: 10.1007/s00392-004-1408-y.
Patients with cardiovascular disease have a poorer diagnosis if they are diabetic. The risk for cardiovascular events is already increased in individuals with impaired fasting glucose (IFG). The aim of this study was to evaluate the impact of diabetes mellitus (DM) and IFG on the incidence of atherosclerotic manifestations and on the long-term prognosis of patients with atherosclerosis in various vascular regions.
In a prospective study we included 906 patients (72.5% men, mean age 62 +/- 9 years) preceding heart catheterization. All patients were evaluated for the presence of peripheral stenosis by carotid duplex sonography (pathologic: stenosis >50%) and evaluation of the ankle-brachial index (pathologic <0.9). Blood samples were drawn from each subject after an overnight fasting period and serum glucose was evaluated.
Patients were compared with regard to the presence of DM (known DMor fasting glucose > or =126 mg/dL, N = 283, 31.2%) or IFG (fasting glucose >110 and <126 mg/dL, N = 89, 9.8%). Patients with IFG and DM had a higher prevalence of atherosclerotic manifestations in the coronary, carotid and peripheral vessels. Diabetics had the highest prevalence of atherosclerotic manifestations in multiple vascular regions (=advanced atherosclerosis). Cardiovascular events (death, myocardial infarction and stroke) after a median follow-up of 4.1 years were evaluated in 901 patients (99.4%). Presence of IFG and DM significantly increased the incidence of cardiovascular events (event rate: no DM 10.9%, IFG 13.6%, DM 23.4%, P < 0.0001). Moreover, patients with advanced atherosclerosis suffered significantly more often from cardiovascular events (event rate: no stenosis 4.1%, coronary artery disease without peripheral stenosis 9.7%, advanced atherosclerosis 23.9%). Prognosis was worst in patients with DM and advanced atherosclerosis with an event rate of 35%.Patients with cardiovascular disease have a poorer prognosis if they are diabetic. The risk for cardiovascular events is already increased in individuals with impaired fasting glucose (IFG). The aim of this study was to evaluate the impact of diabetes mellitus (DM) and IFG on the incidence of atherosclerotic manifestations and on the long-term prognosis of patients with atherosclerosis in various vascular regions.
患有心血管疾病的糖尿病患者诊断情况较差。空腹血糖受损（IFG）个体发生心血管事件的风险已经增加。本研究的目的是评估糖尿病（DM）和IFG对动脉粥样硬化表现的发生率以及不同血管区域动脉粥样硬化患者长期预后的影响。
在一项前瞻性研究中，我们纳入了906例接受心脏导管插入术的患者（男性占72.5%，平均年龄62±9岁）。所有患者均通过颈动脉双功超声检查评估外周狭窄情况（病理性：狭窄>50%）并评估踝臂指数（病理性<0.9）。在过夜禁食期后采集每位受试者的血样并评估血清葡萄糖。
根据是否存在DM（已知DM或空腹血糖≥126mg/dL，N = 283，31.2%）或IFG（空腹血糖>110且<126mg/dL，N = 89，9.8%）对患者进行比较。IFG和DM患者在冠状动脉、颈动脉和外周血管中动脉粥样硬化表现的患病率更高。糖尿病患者在多个血管区域动脉粥样硬化表现的患病率最高（=晚期动脉粥样硬化）。在901例患者（99.4%）中评估了中位随访4.1年后的心血管事件（死亡、心肌梗死和中风）。IFG和DM的存在显著增加了心血管事件的发生率（事件发生率：无DM为10.9%，IFG为13.6%，DM为23.4%，P<0.0001）。此外，晚期动脉粥样硬化患者发生心血管事件的频率明显更高（事件发生率：无狭窄为4.1%，无外周狭窄的冠状动脉疾病为9.7%，晚期动脉粥样硬化为23.9%）。DM和晚期动脉粥样硬化患者的预后最差，事件发生率为35%。患有心血管疾病的糖尿病患者预后较差。空腹血糖受损（IFG）个体发生心血管事件的风险已经增加。本研究的目的是评估糖尿病（DM）和IFG对动脉粥样硬化表现的发生率以及不同血管区域动脉粥样硬化患者长期预后的影响。
