Department of Endocrinology-Diabetology-Nutrition, Paris-Nord University, Bondy,
Diabetes Care. 2011 Sep;34(9):2101-7. doi: 10.2337/dc11-0480. Epub 2011 Jul 20.
To evaluate if silent myocardial ischemia (SMI) and silent coronary artery disease (CAD) provide significant additional value to routine cardiovascular risk assessment in type 2 diabetic patients.
We followed up to a first cardiovascular event 688 subjects (322 men, aged 59 ± 8 years) out of 731 consecutive asymptomatic type 2 diabetic patients with ≥1 additional risk factor who had been prospectively screened between 1992 and 2006 for SMI by stress myocardial scintigraphy and for silent CAD by coronary angiography.
SMI was found in 207 (30.1%) patients and CAD in 76 of those with SMI. Of the patients, 98 had a first cardiovascular event during a 5.4 ± 3.5 (range: 0.1-19.2) year follow-up period. Cox regression analysis considering parameters predicting events but not SMI and CAD ("routine assessment") showed in univariate analyses that macroproteinuria (hazard ratio [HR] 3.33 [95% CI 1.74-6.35]; P < 0.001), current multifactorial care (0.27 [0.15-0.47]; P < 0.001), and peripheral/carotid occlusive arterial disease (PCOAD; 4.33 [2.15-8.71]; P < 0.001) independently predicted cardiovascular events. When added into the model, SMI (HR 1.76 [1.00-3.12]; P = 0.05) and CAD (2.28 [1.24-4.57]; P < 0.01) were also independently associated with events. SMI added to the prediction of an event in the following 5 years above and beyond routine assessment risk prediction (c statistic with or without SMI 0.788 [0.720-0.855] and 0.705 [0.616-0.794], respectively).
Although screening for SMI and silent CAD should not be systematic, these complications are predictive of cardiovascular events in type 2 diabetic patients in addition to routine risk predictors, especially represented by PCOAD, macroproteinuria, and nonintensive management.
评估 2 型糖尿病患者无症状性心肌缺血（SMI）和无症状性冠状动脉疾病（CAD）是否能为常规心血管风险评估提供显著的附加价值。
我们对 731 例连续的无症状 2 型糖尿病患者进行前瞻性筛查，这些患者至少有 1 个其他危险因素，1992 年至 2006 年间通过应激心肌闪烁显像筛查 SMI，通过冠状动脉造影筛查无症状 CAD。共有 688 例（322 例男性，年龄 59 ± 8 岁）符合条件。在 5.4 ± 3.5 年（范围：0.1-19.2 年）的随访期间，这些患者中有 98 人发生了首次心血管事件。在考虑到预测事件但不包括 SMI 和 CAD 的参数（“常规评估”）的 Cox 回归分析中，单变量分析显示，大量蛋白尿（危险比 [HR] 3.33 [95%CI 1.74-6.35]；P < 0.001）、当前多因素治疗（0.27 [0.15-0.47]；P < 0.001）和外周/颈动脉闭塞性动脉疾病（PCOAD；4.33 [2.15-8.71]；P < 0.001）独立预测心血管事件。当将这些因素加入到模型中时，SMI（HR 1.76 [1.00-3.12]；P = 0.05）和 CAD（HR 2.28 [1.24-4.57]；P < 0.01）也与事件独立相关。SMI 可在常规评估风险预测的基础上，进一步提高对未来 5 年内事件的预测能力（有或没有 SMI 的 C 统计量分别为 0.788 [0.720-0.855]和 0.705 [0.616-0.794]）。
尽管筛查 SMI 和无症状性 CAD 不应该是系统性的，但这些并发症除了常规风险预测因素外，还可以预测 2 型糖尿病患者的心血管事件，特别是代表了 PCOAD、大量蛋白尿和非强化管理。
