Costacou Tina, Huskey Nathan D, Edmundowicz Dan, Stolk Ronald, Orchard Trevor J
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
Metabolism. 2006 Dec;55(12):1689-96. doi: 10.1016/j.metabol.2006.08.012.
Coronary artery calcification (CAC) has been used as a testing modality for coronary atherosclerosis burden. In diabetes, arterial calcification in the tunica media is common and predicts renal and cardiovascular mortality. It is unknown whether the 2 calcification processes are related. We identified risk factors associated with lower-extremity arterial calcification (LEAC) and determined its relationship to the presence of CAC 6 years later and the incidence of complications in type 1 diabetes mellitus. A random sample of 190 participants from the Pittsburgh Epidemiology of Diabetes Complications Study, a prospective cohort of childhood-onset type 1 diabetes mellitus, received radiographs of their ankles and feet at the 4-year follow-up examination (1990-1992) and was followed up for approximately 6 years. At the 10-year examination, 121 of these individuals received an electron beam tomography scan. Male sex (odds ratio [OR] = 12.72, P < .0001), diabetes duration (OR = 4.53, P < .0001), and autonomic neuropathy (AN; OR = 5.92, P = .007) independently increased the odds of LEAC. Controlling for other known risk factors (duration and high-density lipoprotein cholesterol), we found that LEAC correlated with the presence of CAC 6 years later (OR = 1.12, P = .03), although adjusting for neuropathy attenuated this relationship (P = .08). LEAC also independently predicted AN but not the onset of other diabetes complications. Although arterial calcification in the lower extremities and the heart share many of the same risk factors, LEAC is an independent correlate of the later presence of CAC and AN. Thus, factors related to the calcification process in addition to vascular risk factors may play a role in determining the extent of CAC.
冠状动脉钙化（CAC）已被用作检测冠状动脉粥样硬化负荷的一种手段。在糖尿病患者中，中膜动脉钙化很常见，并且可预测肾脏和心血管疾病死亡率。目前尚不清楚这两种钙化过程是否相关。我们确定了与下肢动脉钙化（LEAC）相关的危险因素，并确定了其与6年后CAC的存在以及1型糖尿病并发症发生率之间的关系。从匹兹堡糖尿病并发症流行病学研究中随机抽取190名参与者，该研究是一个儿童期发病的1型糖尿病前瞻性队列，在4年随访检查（1990 - 1992年）时接受了脚踝和足部的X光片检查，并随访了约6年。在10年检查时，其中121人接受了电子束断层扫描。男性（优势比[OR]=12.72，P<.0001）、糖尿病病程（OR = 4.53，P<.0001）和自主神经病变（AN；OR = 5.92，P = .007）独立增加了LEAC的发生几率。在控制其他已知危险因素（病程和高密度脂蛋白胆固醇）后，我们发现LEAC与6年后CAC的存在相关（OR = 1.12，P = .03），尽管在调整神经病变后这种关系减弱（P = .08）。LEAC还独立预测了AN，但不能预测其他糖尿病并发症的发生。虽然下肢和心脏的动脉钙化有许多相同的危险因素，但LEAC是后期CAC和AN存在的独立相关因素。因此，除血管危险因素外，与钙化过程相关的因素可能在决定CAC的程度方面起作用。
