Saely Christoph H, Aczel Stefan, Koch Lorena, Schmid Fabian, Marte Thomas, Huber Kurt, Drexel Heinz
Vorarlberg Institute for Vascular Investigation and Treatment, Department of Medicine, Academic Teaching Hospital Feldkirch, Feldkirch, Austria.
Eur J Cardiovasc Prev Rehabil. 2010 Feb;17(1):94-9. doi: 10.1097/HJR.0b013e32833100f0.
Current guidelines consider diabetes per se as a coronary artery disease (CAD) risk equivalent. We aimed at investigating the contribution of baseline coronary atherosclerosis to the risk of diabetic patients for future vascular events.
Prospective cohort study.
Vascular events were recorded over 4 years in 750 consecutive patients undergoing coronary angiography for the evaluation of stable CAD.
From our patients, 244 had neither type 2 diabetes (T2DM) nor significant CAD (i.e. coronary stenoses >or=50%) at the baseline angiography, 50 had T2DM but not significant CAD, 342 did not have T2DM but had significant CAD, and 114 had both T2DM and significant CAD. Nondiabetic patients without significant CAD had an event rate of 9.0%. The event rate was similar in T2DM patients without significant CAD (8.0%, P = 0.951), but higher in nondiabetic patients with significant CAD (24.9%, P<0.001). Patients with T2DM and significant CAD had the highest event rate (43.0%). Importantly, T2DM patients without significant CAD had a significantly lower event rate than nondiabetic patients with significant CAD (P = 0.008).
T2DM per se is not a CAD risk equivalent. Moderate-risk diabetic patients without significant CAD and very high-risk diabetic patients with significant CAD add up to a grand total of high-risk diabetic patients, this is why diabetes seems to be a CAD risk equivalent in many epidemiological studies.
当前指南将糖尿病本身视为冠状动脉疾病（CAD）的风险等同物。我们旨在研究基线冠状动脉粥样硬化对糖尿病患者未来血管事件风险的影响。
前瞻性队列研究。
对750例因评估稳定性CAD而接受冠状动脉造影的连续患者进行了4年的血管事件记录。
在我们的患者中，244例在基线血管造影时既无2型糖尿病（T2DM）也无显著CAD（即冠状动脉狭窄≥50%），50例有T2DM但无显著CAD，342例无T2DM但有显著CAD，114例既有T2DM又有显著CAD。无显著CAD的非糖尿病患者的事件发生率为9.0%。无显著CAD的T2DM患者的事件发生率与之相似（8.0%，P = 0.951），但有显著CAD的非糖尿病患者的事件发生率更高（24.9%，P<0.001）。既有T2DM又有显著CAD的患者事件发生率最高（43.0%）。重要的是，无显著CAD的T2DM患者的事件发生率显著低于有显著CAD的非糖尿病患者（P = 0.008）。
T2DM本身并非CAD的风险等同物。无显著CAD的中度风险糖尿病患者和有显著CAD的极高风险糖尿病患者加起来构成了高风险糖尿病患者的总数，这就是为什么在许多流行病学研究中糖尿病似乎是CAD的风险等同物。
