Parhofer K G, Zeymer U, Stark R G, Binz C, Schwertfeger M, Bhatt D L, Steg Ph G, Röther J
Department of Internal Medicine II, Grosshadern, Ludwig-Maximilians University, Munich, Germany.
Exp Clin Endocrinol Diabetes. 2010 Jan;118(1):51-6. doi: 10.1055/s-0029-1225648. Epub 2009 Oct 15.
Atherothrombosis can present as coronary artery disease (CAD) cerebrovascular disease (CVD) and peripheral arterial disease (PAD). It is unknown whether diabetics with CAD differ from those with other manifestations of atherothrombosis such as CVD or PAD regarding clinical characteristics, biochemical parameters, or medications.
The REACH (REduction of Atherothrombosis for Continued Health) registry evaluated 67 888 patients with established atherothrombosis or risk factors. Of 5 646 recruited German patients, 2 381 (42%) are diabetic. Of these 1 438 (60%) have CAD (either only CAD or in combination with CVD and/or PAD - CAD group) and 520 (22%) have other manifestations of atherothrombosis (either CVD or PAD or both - other manifestation group) and 18% have only risk factors. Differences between diabetics with CAD and diabetics with other manifestations of atherothrombosis were evaluated with multivariate models (79% male, 69+/-9 years, BMI 29+/-5 kg/m (2)) (SAS9.1).
After correcting for age, sex and BMI, CAD patients receive (OR; 95% CI) more aspirin (1.5; 1.2-1.9; p=0.0002), statins (3.1; 2.6-3.7), beta-blockers (4.0; 3.8-4.8), diuretics (1.4; 1.2-1.6), ACE-inhibitors/ARBs (1.4; 1.2-1.7) and nitrates (8.8; 6.7-11.7) and significantly less often metformin (0.75; 0.61-0.93; p=0.01) with no differences concerning other antidiabetics. This resulted in significantly (p<0.05) lower blood-pressure (CAD 142/81 mmHg, other manifestations 145/82 mmHg) and LDL-cholesterol levels (CAD 108+/-37 mg/dl, other manifestations 123+/-37 mg/dl). Therefore more CAD patients reach LDL and blood-pressure-goals (CAD 47%/33%; other manifestations 30%/24%, respectively). Only few patients (CAD 7.1%, other manifestations 4.1%) reach all treatment goals. Furthermore, less CAD patients than patients with other manifestations of atherothrombosis are current smokers (11% vs. 22%).
These data indicate considerable treatment differences between diabetics with CAD and those with other manifestations of atherothrombosis such as CVD or PAD. CAD patients are treated more intensively and therefore reach lower lipid and blood-pressure values.
动脉粥样硬化血栓形成可表现为冠状动脉疾病（CAD）、脑血管疾病（CVD）和外周动脉疾病（PAD）。目前尚不清楚患有CAD的糖尿病患者在临床特征、生化参数或药物治疗方面是否与患有动脉粥样硬化血栓形成其他表现（如CVD或PAD）的患者有所不同。
REACH（降低动脉粥样硬化血栓形成以持续健康）注册研究评估了67888例已确诊动脉粥样硬化血栓形成或有风险因素的患者。在招募的5646例德国患者中，2381例（42%）为糖尿病患者。其中，1438例（60%）患有CAD（仅CAD或合并CVD和/或PAD——CAD组），520例（22%）患有动脉粥样硬化血栓形成的其他表现（CVD或PAD或两者皆有——其他表现组），另有18%仅有风险因素。采用多变量模型（79%为男性，69±9岁，体重指数29±5kg/m²）（SAS9.1）评估患有CAD的糖尿病患者与患有动脉粥样硬化血栓形成其他表现的糖尿病患者之间的差异。
在校正年龄、性别和体重指数后，CAD患者服用（比值比；95%置信区间）更多的阿司匹林（1.5；1.2 - 1.9；p = 0.0002）、他汀类药物（3.1；2.6 - 3.7）、β受体阻滞剂（4.0；3.8 - 4.8）、利尿剂（1.4；1.2 - 1.6）、血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（1.4；1.2 - 1.7）和硝酸盐类药物（8.8；6.7 - 11.7），而服用二甲双胍的频率显著更低（0.75；0.61 - 0.93；p = 0.01），其他抗糖尿病药物无差异。这导致CAD患者的血压（CAD为142/81mmHg，其他表现为145/82mmHg）和低密度脂蛋白胆固醇水平显著（p < 0.05）更低（CAD为108±37mg/dl，其他表现为123±37mg/dl）。因此，更多CAD患者达到低密度脂蛋白和血压目标（CAD分别为47%/33%；其他表现分别为30%/24%）。只有少数患者（CAD为7.1%；其他表现为4.1%）达到所有治疗目标。此外，与患有动脉粥样硬化血栓形成其他表现的患者相比，CAD患者中当前吸烟者更少（11%对22%）。
这些数据表明，患有CAD的糖尿病患者与患有动脉粥样硬化血栓形成其他表现（如CVD或PAD）的患者在治疗方面存在显著差异。CAD患者接受的治疗更为强化，因此血脂和血压值更低。
