Department of Medical Sciences, Postgraduate School of Internal Medicine, University of Turin, Turin, Italy.
Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Diabetes Care. 2020 Apr;43(4):726-733. doi: 10.2337/dc19-2165. Epub 2020 Feb 20.
Dysglycemia, in this survey defined as impaired glucose tolerance (IGT) or type 2 diabetes, is common in patients with coronary artery disease (CAD) and associated with an unfavorable prognosis. This European survey investigated dysglycemia screening and risk factor management of patients with CAD in relation to standards of European guidelines for cardiovascular subjects.
The European Society of Cardiology's European Observational Research Programme (ESC EORP) European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) V (2016-2017) included 8,261 CAD patients, aged 18-80 years, from 27 countries. If the glycemic state was unknown, patients underwent an oral glucose tolerance test (OGTT) and measurement of glycated hemoglobin A. Lifestyle, risk factors, and pharmacological management were investigated.
A total of 2,452 patients (29.7%) had known diabetes. OGTT was performed in 4,440 patients with unknown glycemic state, of whom 41.1% were dysglycemic. Without the OGTT, 30% of patients with type 2 diabetes and 70% of those with IGT would not have been detected. The presence of dysglycemia almost doubled from that self-reported to the true proportion after screening. Only approximately one-third of all coronary patients had completely normal glucose metabolism. Of patients with known diabetes, 31% had been advised to attend a diabetes clinic, and only 24% attended. Only 58% of dysglycemic patients were prescribed all cardioprotective drugs, and use of sodium-glucose cotransporter 2 inhibitors (3%) or glucagon-like peptide 1 receptor agonists (1%) was small.
Urgent action is required for both screening and management of patients with CAD and dysglycemia, in the expectation of a substantial reduction in risk of further cardiovascular events and in complications of diabetes, as well as longer life expectancy.
在本研究中，血糖异常定义为糖耐量受损（IGT）或 2 型糖尿病，在冠心病（CAD）患者中较为常见，且与不良预后相关。该欧洲研究调查了 CAD 患者的血糖异常筛查和危险因素管理情况，以评估其与欧洲心血管疾病指南标准的一致性。
欧洲心脏病学会的欧洲观察性研究计划（ESC EORP）欧洲以干预减少事件的二级和一级预防行动（EUROASPIRE）V 期（2016-2017 年）纳入了来自 27 个国家的 8261 名年龄在 18-80 岁之间的 CAD 患者。如果血糖状态未知，患者将进行口服葡萄糖耐量试验（OGTT）和糖化血红蛋白 A 测量。研究了生活方式、危险因素和药物治疗管理情况。
共有 2452 名（29.7%）患者已知患有糖尿病。4440 名血糖状态未知的患者进行了 OGTT，其中 41.1%为血糖异常。如果不进行 OGTT，将有 30%的 2 型糖尿病患者和 70%的 IGT 患者未被检出。在进行筛查后，血糖异常的检出率几乎是自我报告的两倍。只有大约三分之一的所有冠心病患者具有完全正常的葡萄糖代谢。在已知患有糖尿病的患者中，31%被建议就诊于糖尿病诊所，但只有 24%的患者就诊。仅有 58%的血糖异常患者被开具了所有的心脏保护药物，且钠-葡萄糖共转运蛋白 2 抑制剂（3%）或胰高血糖素样肽 1 受体激动剂（1%）的使用率较低。
迫切需要对 CAD 和血糖异常患者进行筛查和管理，以期望大幅降低进一步心血管事件的风险以及糖尿病并发症的风险，并延长预期寿命。
