Ramírez Torres José Manuel, López Téllez Antonio, Valdivielso Pedro, Barbancho Fernández Miguel Ángel
Centro de Salud Puerta Blanca, Málaga, España.
Centro de Salud Puerta Blanca, Málaga, España.
Clin Investig Arterioscler. 2019 Jul-Aug;31(4):160-165. doi: 10.1016/j.arteri.2019.01.003. Epub 2019 Apr 7.
To assess the atherosclerotic burden in hypertensive patients with prediabetes without cardiovascular disease.
We included patients with hypertension and prediabetes (fasting blood glucose: 100-125mg/dL and/or glycohemoglobin A1c: 5.7-6.4%), excluding those with established cardiovascular disease or those at very high risk. We recorded major vascular risk factors. Subclinical arteriosclerosis was measured by the ankle/brachial index (ABI) and carotid intima-medial thickness (IMT). Subclinical arteriosclerosis was mild if IMT was >75p adjusted by age and sex and/or ABI was 0.7-0.9 and was considered moderate-severe when there was plaque and/or ABI<0.7.
We included 53 patients, 63±7 years-old; women: 50,9% (95%CI: 36.8-64.9). Atherosclerotic burden was detected in 66.0% (95%CI: 51.7-78.5) of subjects. 24,5% (95%CI: 13.8-38.3) of patients had mild arteriosclerosis disease and 41.5% (95%CI: 28.1-55.9) had moderate-severe. This allowed us to re-stratified as very high vascular risk the 41.5% (95%CI: 28.1-55.9) of patients. 45.4% (95%CI: 16-74.8) of subjects with moderate initial risk were considered high or very high risk. In multivariate analyses, only smoking was associated with atherosclerotic burden (P=.07).
Two thirds of hypertensive patients with prediabetes had subclinical arteriosclerotic disease when they were evaluated by the ankle/brachial index and carotid ultrasonography. Approximately forty percent of patients were re-stratified as very high vascular risk. Nearly half of the prediabetic hypertensive patients initially classified as moderate risk were considered high or very high risk.
评估无心血管疾病的糖尿病前期高血压患者的动脉粥样硬化负担。
我们纳入了患有高血压和糖尿病前期（空腹血糖：100 - 125mg/dL和/或糖化血红蛋白A1c：5.7 - 6.4%）的患者，排除已确诊心血管疾病或极高风险的患者。我们记录了主要血管危险因素。通过踝臂指数（ABI）和颈动脉内膜中层厚度（IMT）测量亚临床动脉硬化。若IMT经年龄和性别校正后>75μm且/或ABI为0.7 - 0.9，则亚临床动脉硬化为轻度；若存在斑块和/或ABI<0.7，则认为是中度至重度。
我们纳入了53例患者，年龄63±7岁；女性占50.9%（95%CI：36.8 - 64.9）。66.0%（95%CI：51.7 - 78.5）的受试者检测到动脉粥样硬化负担。24.5%（95%CI：13.8 - 38.3）的患者患有轻度动脉硬化疾病，41.5%（95%CI：28.1 - 55.9）患有中度至重度。这使我们将41.5%（95%CI：28.1 - 55.9）的患者重新分类为极高血管风险。45.4%（95%CI：16 - 74.8）初始风险为中度的受试者被认为是高风险或极高风险。在多变量分析中，只有吸烟与动脉粥样硬化负担相关（P = 0.07）。
通过踝臂指数和颈动脉超声评估时，三分之二的糖尿病前期高血压患者患有亚临床动脉硬化疾病。约40%的患者被重新分类为极高血管风险。近一半最初分类为中度风险的糖尿病前期高血压患者被认为是高风险或极高风险。
