Tanaka Yoshimitsu, Fukui Michiaki, Tanaka Muhei, Fukuda Yukiko, Mitsuhashi Kazuteru, Okada Hiroshi, Yamazaki Masahiro, Hasegawa Goji, Yoshioka Keiji, Nakamura Naoto
Department of Diabetes and Endocrine Diseases, Matsushita Memorial Hospital, Moriguchi, Osaka, Japan.
Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan.
Hypertens Res. 2014 Jun;37(6):548-52. doi: 10.1038/hr.2014.30. Epub 2014 Mar 6.
Recent studies have suggested that the inter-arm blood pressure difference (IAD) is associated with cardiovascular events and mortality. The aim of this study was to assess whether the IAD could be a marker for subclinical atherosclerosis in patients with type 2 diabetes who are at high risk of cardiovascular disease (CVD). In a cross-sectional retrospective study of 206 Japanese patients with type 2 diabetes aged 49-76 years, we examined the correlation of the IAD with the carotid intima-media thickness (IMT), ankle-brachial index (ABI) or cardio ankle vascular index (CAVI). The IAD was positively correlated with the maximum IMT (r=0.266, P<0.0001), mean IMT (r=0.209, P=0.00726) or CAVI (r=0.240, P=0.0005). The IAD was higher in patients with CVD than in those without (P=0.0020). A multiple linear regression analysis demonstrated that the IAD was an independent determinant of maximum IMT (β=0.169, P=0.0167), mean IMT (β=0.178, P=0.0153), ABI (β=-0.222, P=0.0033) or CAVI (β=0.213, P=0.0011) after adjusting for known risk factors. The area under the receiver operating characteristic curve (AUC) of the IAD as a predictor of subclinical atherosclerosis was similar to the AUC of the Framingham 10-year coronary heart disease risk score. In conclusion, the IAD could be a novel risk marker for subclinical atherosclerosis in patients with type 2 diabetes.
近期研究表明，双臂血压差值（IAD）与心血管事件及死亡率相关。本研究旨在评估IAD是否可作为心血管疾病（CVD）高危的2型糖尿病患者亚临床动脉粥样硬化的标志物。在一项对206名年龄在49 - 76岁的日本2型糖尿病患者的横断面回顾性研究中，我们检测了IAD与颈动脉内膜中层厚度（IMT）、踝臂指数（ABI）或心踝血管指数（CAVI）之间的相关性。IAD与最大IMT（r = 0.266，P < 0.0001）、平均IMT（r = 0.209，P = 0.00726）或CAVI（r = 0.240，P = 0.0005）呈正相关。有CVD的患者IAD高于无CVD的患者（P = 0.0020）。多元线性回归分析表明，在调整已知危险因素后，IAD是最大IMT（β = 0.169，P = 0.0167）、平均IMT（β = 0.178，P = 0.0153）、ABI（β = -0.222，P = 0.0033）或CAVI（β = 0.213，P = 0.0011）的独立决定因素。IAD作为亚临床动脉粥样硬化预测指标的受试者工作特征曲线下面积（AUC）与弗雷明汉10年冠心病风险评分的AUC相似。总之，IAD可能是2型糖尿病患者亚临床动脉粥样硬化的一种新型风险标志物。
