Department of Internal Medicine II, Division of Angiology, Medical University of Vienna, Vienna, Austria.
Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.
Cardiovasc Diabetol. 2019 Jul 12;18(1):90. doi: 10.1186/s12933-019-0895-0.
Experimental and clinical data indicate a major influence of diabetes on atherogenesis. We aimed to assess whether the effect of diabetes on long-term mortality in asymptomatic patient with carotid stenosis is contingent upon the degree of the carotid atherosclerotic burden.
1065 patients with neurological asymptomatic carotid atherosclerosis as evaluated by duplex sonography were prospectively followed for cause-specific mortality.
During a median of 11.8 years, a total of 549 deaths, including 362 cardiovascular deaths, were recorded. Diabetes and glycohemoglobin A1c (Hba1c) levels were significantly associated with mortality. Diabetes displayed an independent risk for all-cause (adjusted HR 1.62; 95% CI 1.35-1.94) and cardiovascular death (adjusted HR 1.75, 95% CI 1.40-2.19). The adjusted hazard ratio per increase of 1% of Hba1c levels was 1.21 (P < 0.01) for all-cause and 1.31 (P < 0.01) for cardiovascular mortality, respectively. Patients with diabetes mellitus and a higher degree of carotid stenosis and were at great risk of adverse outcome. Only 21% of the asymptomatic diabetic patients with carotid narrowing over 50% survived, whereas 62% of the patients without diabetes and with carotid atherosclerosis below 50% were still alive after 12-years of follow-up. The high risk for all-cause and cardiovascular death of these patients remained significant after adjustment for various established cardiovascular risk factors in multivariable regression analysis (adjusted hazard ratio 2.4, P < 0.001; compared to patients without diabetes and < 50% carotid atherosclerosis).
Diabetic patients with carotid stenosis ≥ 50% are at exceptional high risk for all-cause and cardiovascular death. Thus, routinely ultrasound investigation of the carotid arteries might be a valuable prognostic tool for patients with diabetes mellitus.
实验和临床数据表明糖尿病对动脉粥样硬化形成有重要影响。我们旨在评估糖尿病对无症状颈动脉狭窄患者长期死亡率的影响是否取决于颈动脉粥样硬化负担的程度。
1065 例经双功能超声检查评估为无症状颈动脉粥样硬化的患者前瞻性随访，以确定特定原因的死亡率。
在中位数为 11.8 年的随访期间，共记录了 549 例死亡，包括 362 例心血管死亡。糖尿病和糖化血红蛋白（HbA1c）水平与死亡率显著相关。糖尿病与全因死亡（调整后的 HR 1.62；95%CI 1.35-1.94）和心血管死亡（调整后的 HR 1.75，95%CI 1.40-2.19）均有独立的风险。HbA1c 水平每增加 1%，全因死亡的调整危险比为 1.21（P<0.01），心血管死亡的调整危险比为 1.31（P<0.01）。患有糖尿病且颈动脉狭窄程度较高的患者发生不良后果的风险较大。无症状糖尿病患者中颈动脉狭窄超过 50%的患者仅有 21%存活，而无糖尿病且颈动脉粥样硬化小于 50%的患者在 12 年的随访后仍有 62%存活。在多变量回归分析中，调整各种已确立的心血管危险因素后，这些患者的全因和心血管死亡的高风险仍然显著（调整后的危险比 2.4，P<0.001；与无糖尿病和<50%颈动脉粥样硬化的患者相比）。
颈动脉狭窄≥50%的糖尿病患者发生全因和心血管死亡的风险极高。因此，常规进行颈动脉超声检查可能是糖尿病患者有价值的预后工具。
