运动能力是糖尿病和非糖尿病患者不良心血管结局的独立危险因素。
Exercise capacity as an independent risk factor for adverse cardiovascular outcomes among nondiabetic and diabetic patients.
机构信息
Department of Medicine, Columbia University Medical Center Harlem Hospital Center, New York, USA.
Massachusetts General Hospital Harvard Medical School, Boston, USA.
出版信息
Arch Med Sci. 2014 Feb 24;10(1):25-32. doi: 10.5114/aoms.2014.40731. Epub 2014 Feb 23.
INTRODUCTION
To investigate if decreased exercise capacity is an independent risk factor for major adverse cardiovascular events (MACE) in diabetics and nondiabetics.
MATERIAL AND METHODS
The association of decreased exercise capacity (EC) during a treadmill exercise sestamibi stress test with MACE was investigated in 490 nondiabetics and 404 diabetics. Mean follow-up was 53 months.
RESULTS
Nondiabetics with a predicted EC < 85% had a higher prevalence of myocardial ischemia (34% vs. 19%, p = 0.0002), 2- or 3-vessel obstructive coronary artery disease (CAD) (31% vs. 13%, p = 0.016), myocardial infarction (MI) (17% vs. 7%, p = 0.0005), stroke (8% vs. 2%, p = 0.002), death (11% vs. 3%, p = 0.0002), and MI or stroke or death at follow-up (32% vs. 11%, p < 0.001) compared to nondiabetics with a predicted EC ≥ 85%. Diabetics with a predicted EC < 85% had a higher prevalence of myocardial ischemia (48% vs. 32%, p = 0.0009), 2- or 3-vessel obstructive CAD (54% vs. 28%, p = 0.001), MI (32% vs. 14%, p < 0.001), stroke (22% vs. 6%, p < 0.001), death (17% vs. 9%, p = 0.031), and MI or stroke or death at follow-up (65% vs. 27%, p < 0.001). Stepwise Cox regression analysis showed decreased EC was an independent and significant risk factor for MACE among nondiabetics (hazard ratio 3.3, p < 0.0001) and diabetics (hazard ratio 2.7, p < 0.0001).
CONCLUSIONS
Diabetics and nondiabetics with decreased EC were at increased risk for MACE with nondiabetics and decreased EC at similar risk as diabetics with normal EC.
简介
为了研究运动能力下降是否是糖尿病患者和非糖尿病患者发生主要不良心血管事件（MACE）的独立危险因素。
材料和方法
在 490 名非糖尿病患者和 404 名糖尿病患者中，研究了平板运动锝-99m 单光子发射计算机断层扫描心肌灌注试验（ sestamibi SPECT）中运动能力下降（EC）与 MACE 的关系。平均随访时间为 53 个月。
结果
预计 EC<85%的非糖尿病患者心肌缺血（34% vs. 19%，p=0.0002）、2 或 3 支血管阻塞性冠心病（CAD）（31% vs. 13%，p=0.016）、心肌梗死（MI）（17% vs. 7%，p=0.0005）、中风（8% vs. 2%，p=0.002）、死亡（11% vs. 3%，p=0.0002）的发生率较高，随访期间 MI、中风或死亡（32% vs. 11%，p<0.001）的发生率也较高。预计 EC<85%的糖尿病患者心肌缺血（48% vs. 32%，p=0.0009）、2 或 3 支血管阻塞性 CAD（54% vs. 28%，p=0.001）、MI（32% vs. 14%，p<0.001）、中风（22% vs. 6%，p<0.001）、死亡（17% vs. 9%，p=0.031）和随访期间 MI、中风或死亡（65% vs. 27%，p<0.001）的发生率较高。逐步 Cox 回归分析显示，非糖尿病患者和糖尿病患者的 EC 降低均为 MACE 的独立且显著危险因素（非糖尿病患者的危险比为 3.3，p<0.0001；糖尿病患者的危险比为 2.7，p<0.0001）。
结论
EC 降低的糖尿病患者和非糖尿病患者发生 MACE 的风险增加，EC 降低的非糖尿病患者与 EC 正常的糖尿病患者发生 MACE 的风险相似。
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