Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Eur J Prev Cardiol. 2013 Apr;20(2):209-17. doi: 10.1177/2047487312437931. Epub 2012 Jan 31.
Diabetic patients with coronary artery disease (CAD) demonstrate accelerated progression of coronary atherosclerosis. The impact of multiple risk factor intervention on disease progression has not been investigated.
We investigated 448 diabetic patients with angiographic CAD who underwent serial intravascular ultrasound imaging to monitor the change in atheroma burden in seven clinical trials.
Disease progression was compared in patients stratified according to whether they achieved increasing numbers of treatment goals of individual risk factors (HbA1c <7.0%, LDL cholesterol <2.5 mmol/l, triglyceride <1.7 mmol/l, systolic blood pressure <130 mmHg, high sensitivity C-reactive protein <2.0 mg/l).
A high rate of established medical therapies was used in all patients (89% statins, 94% aspirin, 76% β-blockers, 66% ACE inhibitors, 66% metformin, 62% thiazolidinediones, 17% insulin). No differences were observed with regard to percentage atheroma volume (PAV) and total atheroma volume (TAV) at baseline. On serial evaluation, slowing of progression of PAV (p = 0.01) and TAV (p < 0.001) was observed with increasing numbers of risk factors achieving treatment goals. On multivariate analysis adjusting for baseline risk factors, increasing the number of factors meeting treatment goals continued to be associated with a beneficial impact on progression of PAV (p = 0.03) and TAV (p < 0.001).
The benefit of achieving optimal control of multiple risk factors underscores the need for modification of global risk in patients with diabetes.
患有冠状动脉疾病 (CAD) 的糖尿病患者表现出冠状动脉粥样硬化的加速进展。尚未研究多重危险因素干预对疾病进展的影响。
我们研究了 448 名接受血管内超声成像连续监测 7 项临床试验中动脉粥样斑块负担变化的有造影 CAD 的糖尿病患者。
根据患者是否实现了单个危险因素治疗目标（HbA1c<7.0%、LDL 胆固醇<2.5mmol/l、甘油三酯<1.7mmol/l、收缩压<130mmHg、高敏 C 反应蛋白<2.0mg/l）的数量对患者进行分层，比较疾病进展情况。
所有患者均采用了高比例的既定医疗治疗方法（89%的他汀类药物、94%的阿司匹林、76%的β受体阻滞剂、66%的 ACE 抑制剂、66%的二甲双胍、62%的噻唑烷二酮、17%的胰岛素）。基线时，斑块体积百分比（PAV）和总斑块体积（TAV）无差异。在连续评估中，随着实现治疗目标的危险因素数量增加，PAV（p=0.01）和 TAV（p<0.001）的进展速度减慢。在校正基线危险因素后进行多变量分析，发现增加符合治疗目标的因素数量与 PAV（p=0.03）和 TAV（p<0.001）的有益进展仍相关。
实现多种危险因素最佳控制的益处强调了需要对糖尿病患者的整体风险进行调整。
