Dodos Ilias, Georgopoulos Sotirios, Dodos Konstantinos, Konstantakopoulou Olympia, Grammatoglou Xanthippi, Dervisis Konstantinos, Bakoyiannis Christos, Klonaris Christos
General Hospital Konstantopouleio, Vascular Surgery Department, Athens, Attica, Greece.
General Hospital of Athens Laiko, 1st Surgical Department, National and Kapodistrian University of Athens, Athens, Attica, Greece.
Ann Vasc Surg. 2019 Nov;61:218-226. doi: 10.1016/j.avsg.2019.04.013. Epub 2019 Jul 22.
The purpose of this study is to investigate the correlation of glycosylated hemoglobin (HbA1c) levels with histological characters of atherosclerotic plaque that makes it vulnerable, as well as ultrasound (US) criteria that can contribute to the prognosis of carotid disease.
This is a single-center prospective study. Our study population consists of 74 diabetic and nondiabetic patients with carotid atherosclerosis who underwent carotid endarterectomy in our department. Patient categorization was based on the following criteria: levels of HbA1c, gender, and risk factors (smoking, hypertension), carotid stenosis rate, symptomatic or asymptomatic carotid disease, histological examination of the atherosclerotic plaque, and US morphological criteria of the plaque.
The mean age of the patients was 68.2 years (standard deviation = 7.8); 58.1% were smokers, 71.6% had arterial hypertension, 37.8% had symptomatic carotid disease, and 64.9% had atherosclerotic plaque type 6. Futhermore, 95.9% of the patients had a carotid stenosis rate more than 70% and 4.1% had from 50% to 69%. Older patients had more frequent type 7 and 8 atherosclerotic plaque based on American Heart Association scoring system than younger patients (P = 0.041). The relative likelihood of atherosclerotic plaque type 7 and 8 was 1.12 times higher in older patients (Odds ratio [OR] = 1.12, P = 0.029). Patients with higher levels of HbA1cwere more likely to have type 6 atherosclerotic plaque than those with atherosclerotic lesions type 7 and 8 (P < 0.001). Specifically, increasing the level of HbA1c by 1 mg/dl increases the likelihood of the presence of vulnerable plaque by 2.55%. Moreover, the relative likelihood of a type 6 atherosclerotic plaque was 10.4 times higher in the older patients (OR = 10.4, P < 0.001).
This study demonstrates that levels of HbA1c and advanced age are 2 factors that may be correlated with the presence of vulnerable carotid plaques in diabetic population. Moreover, HbA1c is an independent factor that could possibly be used as a prognostic marker for carotid artery disease, although further studies are needed to explore this association to elucidate the precise role of HbA1c.
本研究旨在探讨糖化血红蛋白（HbA1c）水平与易损性动脉粥样硬化斑块组织学特征以及有助于预测颈动脉疾病预后的超声（US）标准之间的相关性。
这是一项单中心前瞻性研究。我们的研究对象包括74例在我科接受颈动脉内膜切除术的糖尿病和非糖尿病颈动脉粥样硬化患者。患者分类基于以下标准：HbA1c水平、性别、危险因素（吸烟、高血压）、颈动脉狭窄率、有症状或无症状的颈动脉疾病、动脉粥样硬化斑块的组织学检查以及斑块的超声形态学标准。
患者的平均年龄为68.2岁（标准差 = 7.8）；58.1%为吸烟者，71.6%患有动脉高血压，37.8%患有有症状的颈动脉疾病，64.9%患有6型动脉粥样硬化斑块。此外，95.9%的患者颈动脉狭窄率超过70%，4.1%的患者狭窄率在50%至69%之间。根据美国心脏协会评分系统，老年患者比年轻患者更频繁出现7型和8型动脉粥样硬化斑块（P = 0.041）。老年患者出现7型和8型动脉粥样硬化斑块的相对可能性高1.12倍（优势比[OR] = 1.12，P = 0.029）。HbA1c水平较高的患者比患有7型和8型动脉粥样硬化病变的患者更易出现6型动脉粥样硬化斑块（P < 0.001）。具体而言，HbA1c水平每升高1 mg/dl，出现易损斑块的可能性增加2.55%。此外，老年患者出现6型动脉粥样硬化斑块的相对可能性高10.4倍（OR = 10.4，P < 0.001）。
本研究表明，HbA1c水平和高龄是与糖尿病患者中易损颈动脉斑块存在可能相关的两个因素。此外，HbA1c是一个独立因素，可能用作颈动脉疾病的预后标志物，尽管需要进一步研究来探索这种关联以阐明HbA1c的确切作用。
