Kristensen Katrine Lawaetz, Dahl Marie, Rasmussen Lars Melholt, Lindholt Jes Sanddal
From the Elitary Research Centre of Individualized Medicine in Arterial Disease (K.L.K., L.M.R., J.S.L.), Department of Cardiac, Thoracic, Vascular Surgery, Odense University Hospital, Denmark (K.L.K., J.S.L.); The Danish Diabetes Academy (K.L.K.), and Department of Clinical Biochemistry and Pharmacology (L.M.R.), Odense University Hospital, Denmark; and Cardiovascular Research Unit, Region Hospital Viborg, Denmark (M.D., J.S.L.).
Arterioscler Thromb Vasc Biol. 2017 Apr;37(4):730-736. doi: 10.1161/ATVBAHA.116.308874. Epub 2017 Feb 9.
An inverse association between abdominal aortic aneurysms (AAAs) and diabetes mellitus exists; however, the cause remains unknown. This study aimed to evaluate whether the degree of glycemia is associated with aneurysm growth.
The study was based on VIVA trial (Viborg Vascular), the randomized clinically controlled screening trial for abdominal aortic aneurysm in men aged 65 to 74 years in the Central Denmark Region. The screening included measurement of the abdominal aorta by ultrasound, analysis of glycated hemoglobin (HbA1c), and follow-up for ≤5 years for aneurysms <5 cm. Analyses were conducted using mixed-effect models. At baseline, VIVA screening identified 619 individuals (3.3%) with abdominal aortic aneurysms. A total of 103 individuals were referred for vascular evaluation, and after removal of additional individuals who were lost to follow-up or had missing blood samples, we were left with 319 individuals. Sixty-one individuals (19.1%) had diabetes mellitus. The median growth rate was 1.7 versus 2.7 mm/y in individuals with and without diabetes mellitus, respectively (<0.001). We found a significant inverse association between aneurysmal growth rate and HbA1c in the total study population (=0.002). Both crude and adjusted analyses identified slower growth for the group with the highest HbA1c tertile compared with the lowest HbA1c tertile. After 3 years, the mean difference was 1.8 mm (confidence interval, 0.98-2.64). Similar significant differences were observed in subgroup analysis of individuals without self-reported diabetes mellitus.
We found an inverse association between the growth rate of abdominal aortic aneurysms and the level of HbA1c, indicating that long-lasting elevated blood sugar impairs aneurysmal progression in individuals with and without known diabetes mellitus.
腹主动脉瘤（AAA）与糖尿病之间存在负相关；然而，其原因尚不清楚。本研究旨在评估血糖水平是否与动脉瘤生长相关。
本研究基于VIVA试验（维堡血管试验），这是丹麦中部地区针对65至74岁男性腹主动脉瘤的随机临床对照筛查试验。筛查包括通过超声测量腹主动脉、分析糖化血红蛋白（HbA1c），以及对直径<5 cm的动脉瘤进行≤5年的随访。使用混合效应模型进行分析。在基线时，VIVA筛查确定了619例（3.3%）腹主动脉瘤患者。共有103例患者被转诊进行血管评估，在剔除失访或血样缺失的其他患者后，我们最终纳入了319例患者。61例（19.1%）患有糖尿病。糖尿病患者和非糖尿病患者的中位生长速率分别为1.7 mm/年和2.7 mm/年（<0.001）。我们在整个研究人群中发现动脉瘤生长速率与HbA1c之间存在显著负相关（=0.002）。粗分析和校正分析均显示，与HbA1c三分位数最低组相比，HbA1c三分位数最高组的生长较慢。3年后，平均差异为1.8 mm（置信区间，0.98 - 2.64）。在未自我报告患有糖尿病的个体亚组分析中也观察到了类似的显著差异。
我们发现腹主动脉瘤的生长速率与HbA1c水平之间存在负相关，这表明无论是否患有已知糖尿病，长期血糖升高都会损害动脉瘤的进展。
