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2 型糖尿病患者无既往心血管疾病史时进行年度心血管筛查试验的影响:四年临床结局。

Impact of Annual Cardiovascular Screening Tests in Patients with Type 2 Diabetes Mellitus without Previous Histories of Cardiovascular Disease: Four-year Clinical Outcomes.

机构信息

Cardiovascular Center, Steel Memorial Yawata Hospital, Japan.

Department of Cardiology, Munakata Suikokai General Hospital, Japan.

出版信息

Intern Med. 2021 Sep 1;60(17):2725-2732. doi: 10.2169/internalmedicine.6893-20. Epub 2021 Mar 15.

Abstract

Objective We previously reported that, among asymptomatic patients with type 2 diabetes mellitus (T2DM) without a history of cardiovascular disease (CVD), up to 19% of the patients with myocardial ischemia were detected by annual cardiovascular screening tests (ACVSTs). Thus, the present study assessed the long-term clinical outcomes of ACVSTs in those patients. Methods Six hundred and fifty-seven outpatients with T2DM who received ACVSTs at least once or not at all from April 2014 to March 2018 were defined as the S and NS groups, respectively. The data were compared between these two groups. Results This study revealed that, among outpatients with T2DM in our hospital over those four years, with the increasing frequency of receiving ACVSTs, 1) the frequency of the internal use of statins, anti-platelets, and renin-angiotensin system inhibitors, which are well-known as medications for preventing CVD, significantly increased; 2) low-density lipoprotein-cholesterol and triglyceride levels significantly improved; 3) levels of highly sensitive C-protein, a strong predictors of CVD, were significantly suppressed; 4) the progression of renal dysfunction was significantly suppressed; 5) the cumulative of four-point major adverse cardiovascular events and admissions due to heart failure significantly decreased; and 6) the cumulative of all-cause mortality was significantly suppressed. Conclusions Given the above, it may be important to continue ACVSTs in outpatients with T2DM without a history of CVD for several years.

摘要

目的 我们之前报道过,在没有心血管疾病 (CVD) 病史的 2 型糖尿病 (T2DM) 无症状患者中,通过年度心血管筛查测试 (ACVST) 检测到多达 19%的患者存在心肌缺血。因此,本研究评估了这些患者接受 ACVST 的长期临床结局。

方法 2014 年 4 月至 2018 年 3 月期间,至少接受过一次或未接受过 ACVST 的 657 例 T2DM 门诊患者分别被定义为 S 组和 NS 组,比较两组患者的临床资料。

结果 本研究显示,在过去四年中,我院 T2DM 门诊患者中,随着接受 ACVST 次数的增加:1)内用他汀类药物、抗血小板药物和肾素-血管紧张素系统抑制剂的频率显著增加,这些药物是预防 CVD 的常用药物;2)低密度脂蛋白胆固醇和甘油三酯水平显著改善;3)心血管疾病的强预测因子高敏 C 反应蛋白水平显著降低;4)肾功能不全的进展显著受到抑制;5)四点主要不良心血管事件和因心力衰竭入院的累积发生率显著降低;6)全因死亡率显著降低。

结论 综上,对于无 CVD 病史的 T2DM 门诊患者,连续数年接受 ACVST 可能非常重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/171b/8479217/6e704c0a74d3/1349-7235-60-2725-g001.jpg

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