Lindholt Jes Sanddal, Frystyk Jan, Hallas Jesper, Rasmussen Lars Melholt, Diederichsen Axel Cosmus Pyndt
Elitary Research Centre of Individualised Medicine in Arterial Disease (CIMA), Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark.
Department of Endocrinology, Odense University Hospital, Odense, Denmark.
Clin Epidemiol. 2020 May 6;12:447-455. doi: 10.2147/CLEP.S246636. eCollection 2020.
Cardiovascular mortality remains high among patients with diabetes compared with the general population. The primary aim was to evaluate the interest in and demand for advanced cardiovascular screening in patients with diabetes; the secondary aim was to explore its efficiency in detecting unprotected subclinical cardiovascular disease (CVD).
In a cross-sectional design, randomly selected 40-60-year-old men and women with diabetes were invited to the screening trial. Screening encompassed (1) a comprehensive medical interview; (2) non-contrast computed tomography scanning to quantify coronary artery and aortic valve calcification, to measure left atrial size, to assess heart rhythm and to detect aortic and iliac dilatations; (3) ankle and brachial blood pressure measurements; and (4) blood and urine samples for measurements of HbA, lipid profile, renal function, NT-pro B-type natriuretic peptide (pro-BNP) and albuminuria. Primary outcome was participation rate; secondary outcome was rate of unprotected subclinical CVD.
Of 465 invited patients, 191 (41.1%) attended screening. The participation rate was 40% (95% CI:33-47) for males and 42% (95% CI:36-48) for females. Twenty-four patients were excluded due to previous CVD. The remaining patients' mean age was 52 years; 58% were males. Subclinical CVD was found in 64%, with a male preponderance (males 75% (95% CI:66-83; females 49% (95% CI:37-60)). Presence of severe coronary artery calcification (score ≥ 400) showed a male preponderance (males 19% (95% CI:12-27); females 7% (95% CI:3-16)). Aortic valve calcification, enlarged left atrial volume, atrial fibrillation, aortic dilatations, peripheral artery disease or increased pro-BNP were uncommon, and without any sex differences. Unprotected subclinical CVD was very common, and medical treatment was intensified in 60% (95% CI:53-68) of patients.
We propose a feasible cardiovascular screening examination from which middle-aged patients with diabetes may benefit. However, the participation rate may be too low to warrant screening.
与普通人群相比，糖尿病患者的心血管疾病死亡率仍然很高。主要目的是评估糖尿病患者对高级心血管筛查的兴趣和需求；次要目的是探讨其在检测未受保护的亚临床心血管疾病（CVD）方面的效率。
采用横断面设计，随机邀请40 - 60岁的糖尿病男性和女性参加筛查试验。筛查包括：（1）全面的医学访谈；（2）非增强计算机断层扫描，以量化冠状动脉和主动脉瓣钙化、测量左心房大小、评估心律并检测主动脉和髂动脉扩张；（3）测量踝部和肱部血压；（4）采集血液和尿液样本，用于测量糖化血红蛋白、血脂谱、肾功能、N末端B型利钠肽原（pro-BNP）和蛋白尿。主要结局是参与率；次要结局是未受保护的亚临床CVD发生率。
在465名受邀患者中，191名（41.1%）参加了筛查。男性参与率为40%（95%置信区间：33 - 47），女性为42%（95%置信区间：36 - 48）。24名患者因既往有心血管疾病被排除。其余患者的平均年龄为52岁；58%为男性。64%的患者发现有亚临床CVD，男性占优势（男性75%（95%置信区间：66 - 83）；女性49%（95%置信区间：37 - 60））。严重冠状动脉钙化（评分≥400）显示男性占优势（男性19%（95%置信区间：12 - 27）；女性7%（95%置信区间：3 - 16））。主动脉瓣钙化、左心房容积增大、心房颤动、主动脉扩张、外周动脉疾病或pro-BNP升高并不常见，且无性别差异。未受保护的亚临床CVD非常常见，60%（95%置信区间：53 - 68）的患者强化了药物治疗。
我们提出了一种可行的心血管筛查检查，中年糖尿病患者可能从中受益。然而，参与率可能过低，不足以保证进行筛查。
