冠状动脉钙化与 1 型糖尿病患者心血管疾病发生的相关性：DCCT/EDIC 研究。
The Association of Coronary Artery Calcification With Subsequent Incidence of Cardiovascular Disease in Type 1 Diabetes: The DCCT/EDIC Trials.
机构信息
Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles School of Medicine, Torrance, California.
Department of Biostatistics, George Washington University, Rockville, Maryland.
出版信息
JACC Cardiovasc Imaging. 2019 Jul;12(7 Pt 2):1341-1349. doi: 10.1016/j.jcmg.2019.01.014. Epub 2019 Mar 13.
OBJECTIVES
This study sought to determine the relationship between coronary artery calcium (CAC) scores and subsequent cardiovascular disease (CVD) events in DCCT (Diabetes Control and Complications Trial)/EDIC (Epidemiology of Diabetes Interventions and Complications) participants.
BACKGROUND
The CAC score has been validated for improved risk stratification in general populations; however, this association has not been well studied in type 1 diabetes (T1DM).
METHODS
Computed tomography (CT) to measure CAC was performed in 1,205 DCCT/EDIC participants at a mean of 42.8 years of age during EDIC years 7 to 9, after the end of DCCT. This study analyzed the association between CAC and time to the first subsequent CVD event or to the first major adverse cardiac event (MACE), a follow-up of 10 to 13 years. CAC was categorized as: 0, >0 to 100, >100 to 300, or >300 Agatston units.
RESULTS
Of 1,156 participants at risk for subsequent CVD, 105 had an initial CVD event (8.5 per 1,000 patient-years); and of 1,187 participants at risk for MACE, 51 had an initial MACE event (3.9 per 1,000 patient-years). Event rates among those with scores of zero (n = 817 [70.7%]) were very low for CVD (5.6 per 1,000 patient years). CAC scores >100 to 300 (hazard ratio [HR]: 4.17, 5.40) and >300 (HR: 6.06, 6.91) were associated with higher risks of CVD and MACE, respectively, compared to CAC of 0 (p < 0.0001). CAC scores >0 to 100 were nominally associated with CVD (HR: 1.71; p = 0.0415) but not with MACE (HR: 1.11; p = 0.8134). Similar results were observed when also adjusted for mean HbA and conventional CVD risk factors. The increment in the AUC due to CAC was modest.
CONCLUSIONS
CAC scores >100 Agatston units were significantly associated with an increased risk of the subsequent occurrence of CVD and MACE in DCCT/EDIC cohort. (Diabetes Control and Complications Trial [DCCT]; NCT00360815; Epidemiology of Diabetes Interventions and Complications [EDIC]; NCT00360893).
目的
本研究旨在探讨冠状动脉钙（CAC）评分与 DCCT（糖尿病控制和并发症试验）/EDIC（糖尿病干预和并发症的流行病学）参与者随后发生心血管疾病（CVD）事件之间的关系。
背景
CAC 评分已被验证可改善一般人群的风险分层；然而，在 1 型糖尿病（T1DM）中，这种关联尚未得到很好的研究。
方法
在 EDIC 第 7 至 9 年期间，即 DCCT 结束后，1,205 名 DCCT/EDIC 参与者进行了计算机断层扫描（CT）以测量 CAC，平均年龄为 42.8 岁。本研究分析了 CAC 与首次随后 CVD 事件或首次主要不良心脏事件（MACE）之间的时间关系，随访时间为 10 至 13 年。CAC 分为：0、>0 至 100、>100 至 300、或>300 阿加斯顿单位。
结果
在有发生 CVD 风险的 1,156 名参与者中，有 105 名发生了初始 CVD 事件（每 1,000 名患者年 8.5 例）；在有发生 MACE 风险的 1,187 名参与者中，有 51 名发生了初始 MACE 事件（每 1,000 名患者年 3.9 例）。CAC 评分为零（n=817[70.7%]）的患者发生 CVD 的发生率非常低（每 1,000 患者年 5.6 例）。CAC 评分>100 至 300（HR：4.17，5.40）和>300（HR：6.06，6.91）与 CVD 和 MACE 的风险增加分别相关，与 CAC 评分为 0 相比（p<0.0001）。CAC 评分>0 至 100 与 CVD 呈名义相关（HR：1.71；p=0.0415），但与 MACE 无关（HR：1.11；p=0.8134）。当也调整平均 HbA 和传统 CVD 危险因素时，也观察到类似的结果。由于 CAC 导致 AUC 的增加幅度较小。
结论
CAC 评分>100 阿加斯顿单位与 DCCT/EDIC 队列中随后发生 CVD 和 MACE 的风险增加显著相关。（糖尿病控制和并发症试验 [DCCT]；NCT00360815；糖尿病干预和并发症的流行病学 [EDIC]；NCT00360893）。
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