Che Qianzi, Yang Ying, Cheng Guanliang, Jia Jia, Fan Fangfang, Li Jianping, Huo Yong, Chen Dafang, Zhang Yan
Department of Epidemiology & Biostatistics, Peking University Health Science Center, Beijing, People's Republic of China.
Department of Cardiology, Peking University First Hospital, Beijing, People's Republic of China.
Diabetes Metab Syndr Obes. 2019 Jul 26;12:1263-1273. doi: 10.2147/DMSO.S203545. eCollection 2019.
Type 2 diabetes (T2DM), hypertension and kidney dysfunction are known risk factors for cardiovascular disease, but their combined effect on carotid plaque remains uncertain. This study aims to assess the associations between T2DM, hypertension, kidney dysfunction and carotid plaque, and further explore the combined effect of three diseases.
We conducted a cross-sectional analysis among 3,815 community-dwelling adults in a Chinese atherosclerosis cohort. Estimated glomerular filtration rate (eGFR), hypertension and T2DM were evaluated as risk factors for carotid plaque. The presence, number and total area of carotid plaques were also assessed. Using logistic model, mutinomial logistic model and generalized linear regression model, the relationship between risk factors and carotid plaque was examined.
T2DM, hypertension, decreased GFR, and, inversely, eGFR, were independently associated with the presence, number and total area of carotid plaque. Stratified analysis by T2DM and hypertension showed T2DM attenuated the association between eGFR change and carotid plaque. There was a cumulative relationship between three risk factors and carotid plaque burden. The OR for the number of plaques was 1.0 (reference), 1.55 to 2.03, 1.94 to 3.14, and 3.69 (all <0.05), respectively, for individuals with none, one, two, and three risk factors. Likewise, combining three risk factors was associated with greater increase in total plaque area (, 20.63; 95% CI, 14.04-27.22).
The coexistence of decreased GFR, diabetes and hypertension is associated with increased risk of carotid plaque, and these comorbidities may contribute additively to the development of plaque.
2型糖尿病（T2DM）、高血压和肾功能不全是已知的心血管疾病风险因素，但它们对颈动脉斑块的综合影响仍不确定。本研究旨在评估T2DM、高血压、肾功能不全与颈动脉斑块之间的关联，并进一步探讨这三种疾病的综合影响。
我们对中国动脉粥样硬化队列中的3815名社区成年居民进行了横断面分析。评估估算肾小球滤过率（eGFR）、高血压和T2DM作为颈动脉斑块的风险因素。还评估了颈动脉斑块的存在、数量和总面积。使用逻辑模型、多项逻辑模型和广义线性回归模型，研究风险因素与颈动脉斑块之间的关系。
T2DM、高血压、肾小球滤过率降低以及相反的eGFR，均与颈动脉斑块的存在、数量和总面积独立相关。按T2DM和高血压进行分层分析显示，T2DM减弱了eGFR变化与颈动脉斑块之间的关联。三种风险因素与颈动脉斑块负担之间存在累积关系。对于无、一、二和三种风险因素的个体，斑块数量的OR分别为1.0（参考值）、1.55至2.03、1.94至3.14和3.69（均<0.05）。同样，合并三种风险因素与总斑块面积的更大增加相关（，20.63；95%CI，14.04 - 27.22）。
肾小球滤过率降低、糖尿病和高血压并存与颈动脉斑块风险增加相关，这些合并症可能对斑块的发展产生累加作用。
