Unidad de Investigación en Epidemiología Clínica, Instituto Méxicano del Seguro Social, Gabriel Mancera 222, Col. del Valle, 03100 México DF, México.
Mayo Clin Proc. 2010 Jan;85(1):41-6. doi: 10.4065/mcp.2009.0265.
To evaluate the effect of prior duration of diabetes, glycated hemoglobin level at study entry, and microalbuminuria or macroalbuminuria on the extent and severity of coronary artery disease (CAD) and peripheral arterial disease.
We studied baseline characteristics of the 2368 participants of the BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) study, a randomized clinical trial that evaluates treatment efficacy for patients with type 2 diabetes and angiographically documented stable CAD. Patients were enrolled from January 1, 2001, through March 31, 2005. Peripheral arterial disease was ascertained by an ankle-brachial index (ABI) of 0.9 or less, and extent of CAD was measured by presence of multivessel disease, a left ventricular ejection fraction (LVEF) of less than 50%, and myocardial jeopardy index.
Duration of diabetes of 20 or more years was associated with increased risk of ABI of 0.9 or less (odds ratio [OR], 1.54; 95% confidence interval [CI], 1.04-2.26), intermittent claudication (OR, 1.61; 95% CI, 1.10-2.35), and LVEF of less than 50% (OR, 2.03; 95% CI, 1.37-3.02). Microalbuminuria was associated with intermittent claudication (OR, 1.53; 95% CI, 1.16-2.02) and ABI of 0.9 or less (OR, 1.31; 95% CI, 0.98-1.75), whereas macroalbuminuria was associated with abnormal ABI, claudication, and LVEF of less than 50%. There was a significant association between diabetes duration and extent of CAD as manifested by number of coronary lesions, but no other significant associations were observed between duration of disease, glycated hemoglobin levels, or albumin-to-creatinine ratio and other manifestations of CAD.
Duration of diabetes and microalbuminuria or macroalbuminuria are important predictors of severity of peripheral arterial disease and left ventricular dysfunction in a cohort of patients selected for the presence of CAD.
评估糖尿病病程、研究入组时糖化血红蛋白水平以及微量白蛋白尿或大量白蛋白尿对冠状动脉疾病（CAD）和外周动脉疾病严重程度和范围的影响。
我们研究了 2368 名 BARI 2D（旁路血管成形术血管重建研究 2 型糖尿病）研究参与者的基线特征，这是一项评估 2 型糖尿病患者治疗效果的随机临床试验，这些患者有经血管造影证实的稳定 CAD。患者于 2001 年 1 月 1 日至 2005 年 3 月 31 日入组。通过踝臂指数（ABI）<0.9 来确定外周动脉疾病，通过多血管疾病、左心室射血分数（LVEF）<50%和心肌危险指数来测量 CAD 的范围。
病程 20 年或以上与 ABI<0.9（比值比[OR]，1.54；95%置信区间[CI]，1.04-2.26）、间歇性跛行（OR，1.61；95%CI，1.10-2.35）和 LVEF<50%（OR，2.03；95%CI，1.37-3.02）的风险增加相关。微量白蛋白尿与间歇性跛行（OR，1.53；95%CI，1.16-2.02）和 ABI<0.9（OR，1.31；95%CI，0.98-1.75）相关，而大量白蛋白尿与异常 ABI、跛行和 LVEF<50%相关。糖尿病病程与 CAD 范围（表现为冠状动脉病变数量）之间存在显著关联，但在疾病病程、糖化血红蛋白水平或白蛋白与肌酐比值与 CAD 其他表现之间未观察到其他显著关联。
在选择有 CAD 存在的患者队列中，糖尿病病程和微量白蛋白尿或大量白蛋白尿是外周动脉疾病严重程度和左心室功能障碍的重要预测指标。
