Nakamura Yosuke, Saitoh Shigeyuki, Takagi Satoru, Ohnishi Hirofumi, Chiba Yu, Kato Nobuo, Akasaka Hiroshi, Miura Tetsuji, Tsuchihashi Kazufumi, Shimamoto Kazuaki
Second Department of Internal Medicine, Sapporo Medical University, Japan.
Circ J. 2007 Jan;71(1):20-5. doi: 10.1253/circj.71.20.
The degree to which abnormal glucose tolerance contributes to the development of coronary artery disease (CAD) has not been clarified in Japanese. The relationship between abnormal glucose tolerance and severity of coronary artery stenosis, as well as the contributions of hypertension, diabetes and other risk factors for CAD to recurrence of the disease, were investigated in the present study.
The subjects were 474 consecutive patients (mean age: 63.8+/-11.3 years) with suspected CAD who were admitted to Sapporo Medical University Hospital during April 1, 1997 to March 31, 2004. The coronary index and stenosis score were higher in subjects with diabetes mellitus (DM) and in subjects with impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) than in subjects with normal glucose tolerance (NGT). Ischemic episodes recurred during the observation period (mean 2.5 years) in 61 of 341 patients diagnosed as having CAD. In the follow-up subjects, systolic blood pressure (SBP) was significantly higher in the recurrence group than in the non-recurrence group, and SBP was a significant variable in logistic regression analysis after adjustment for age, gender, hemoglobin A1c, total cholesterol, body mass index, smoking history, family history and stenosis score. The relative risk of recurrence became 1.7-fold higher with a rise in SBP of 10 mmHg (95% confidence interval: 1.252-2.250). Analysis of the relationship between glucose tolerance and recurrence showed that the rate of recurrence was higher in patients with IFG+IGT+DM than in those with NGT.
CAD progresses not only in patients with DM but also in those with IGT. The rate of recurrence of ischemic episodes increases in individuals with IGT or DM, and suggesting that hypertension is a risk factor for recurrence of ischemic episodes. Management of glucose tolerance and blood pressure is therefore important for prevention of CAD in Japanese.
在日本，糖耐量异常对冠状动脉疾病（CAD）发展的影响程度尚未明确。本研究调查了糖耐量异常与冠状动脉狭窄严重程度之间的关系，以及高血压、糖尿病和其他CAD危险因素对该疾病复发的影响。
研究对象为1997年4月1日至2004年3月31日期间入住札幌医科大学医院的474例疑似CAD的连续患者（平均年龄：63.8±11.3岁）。糖尿病（DM）患者、空腹血糖受损（IFG）和糖耐量受损（IGT）患者的冠状动脉指数和狭窄评分高于糖耐量正常（NGT）患者。在341例被诊断为CAD的患者中，有61例在观察期（平均2.5年）内出现缺血事件复发。在随访对象中，复发组的收缩压（SBP）显著高于未复发组，并且在对年龄、性别、糖化血红蛋白、总胆固醇、体重指数、吸烟史、家族史和狭窄评分进行调整后的逻辑回归分析中，SBP是一个显著变量。SBP每升高10 mmHg，复发的相对风险增加1.7倍（95%置信区间：1.252 - 2.250）。糖耐量与复发关系的分析表明，IFG + IGT + DM患者的复发率高于NGT患者。
CAD不仅在DM患者中进展，在IGT患者中也会进展。IGT或DM个体的缺血事件复发率增加，提示高血压是缺血事件复发的一个危险因素。因此，在日本人中，控制糖耐量和血压对于预防CAD很重要。
