State Key Laboratory of Cardiovascular Diseases, Fu Wai Hospital, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 BeiLiShi Road, XiCheng District, Beijing 100037, China.
Eur J Prev Cardiol. 2022 Jan 11;28(16):1807-1816. doi: 10.1093/eurjpc/zwab042.
Type 2 diabetes mellitus (T2DM) is an independent risk factor for cardiovascular disease. However, the association between T2DM and coronary artery disease (CAD) in patients with heterozygous familial hypercholesterolaemia (HeFH) has not been thoroughly evaluated. Our study aimed to assess the effect of T2DM on CAD severity and hard cardiovascular endpoints in a HeFH cohort.
A total of 432 patients with HeFH with a molecular and/or clinical Dutch Lipid Clinic Network score ≥6 (definite and probable) were enrolled. Patients were divided into a T2DM group (n = 99) and a non-T2DM group (n = 333). The severity of coronary stenosis was assessed by the number of diseased vessels and Gensini, SYNTAX, and Jeopardy scores. Hard endpoints included a composite of non-fatal myocardial infarction, non-fatal stroke, and cardiac death. Cox regression and Kaplan-Meier analyses were used to evaluate the effect of T2DM on hard cardiovascular endpoints. The prevalence of CAD was higher in patients with T2DM compared with those without (96.0% vs. 77.5%, respectively; P < 0.001). Patients with T2DM demonstrated a greater number of diseased vessels (P = 0.029) and more severe coronary lesions with high Gensini, SYNTAX, and Jeopardy score tertiles (P = 0.031, P = 0.001, and P = 0.024, respectively). During a median of 3.75 years up to a maximum of 9 years of follow-up, hard endpoints occurred in 13 of 99 patients with T2DM and 16 of 333 without T2DM at baseline. Compared with patients without T2DM, patients with T2DM were at a significantly greater risk of hard endpoints [multivariate adjusted hazard ratio (HR) 2.32, 95% confidence interval (CI) 1.02-4.84; P = 0.025]. Additionally, patients with T2DM and good glucose control (HbA1c < 7.0%) were at a lower risk of hard endpoints compared with those with poor glucose control (HbA1c ≥ 7.0%, HR 0.08, 95% CI 0.01-0.56; P = 0.011).
We conclude that T2DM is an independent predictor of CAD severity when assessed by number of diseased vessels, Gensini, SYNTAX, Jeopardy scores, and hard cardiovascular endpoints, suggesting that T2DM could be further used for risk stratification of patients with HeFH.
2 型糖尿病（T2DM）是心血管疾病的独立危险因素。然而，杂合子家族性高胆固醇血症（HeFH）患者的 T2DM 与冠状动脉疾病（CAD）之间的关联尚未得到充分评估。我们的研究旨在评估 T2DM 对 HeFH 队列中 CAD 严重程度和硬心血管终点的影响。
共纳入了 432 名分子和/或临床荷兰脂质诊所网络评分≥6（明确和可能）的 HeFH 患者。患者分为 T2DM 组（n=99）和非 T2DM 组（n=333）。冠状动脉狭窄的严重程度通过病变血管数量和 Gensini、SYNTAX 和 Jeopardy 评分评估。硬终点包括非致命性心肌梗死、非致命性卒中和心脏死亡的复合终点。Cox 回归和 Kaplan-Meier 分析用于评估 T2DM 对硬心血管终点的影响。与无 T2DM 患者相比，T2DM 患者的 CAD 患病率更高（分别为 96.0%和 77.5%；P<0.001）。T2DM 患者的病变血管数量更多（P=0.029），高 Gensini、SYNTAX 和 Jeopardy 评分 tertiles 的冠状动脉病变更严重（P=0.031、P=0.001 和 P=0.024）。在中位随访 3.75 年（最长 9 年）期间，T2DM 组的 99 名患者中有 13 人，无 T2DM 组的 333 名患者中有 16 人发生了硬终点事件。与无 T2DM 患者相比，T2DM 患者发生硬终点事件的风险显著增加[多变量调整后的危险比（HR）2.32，95%置信区间（CI）1.02-4.84；P=0.025]。此外，与血糖控制不佳（HbA1c≥7.0%）的 T2DM 患者相比，血糖控制良好（HbA1c<7.0%）的 T2DM 患者发生硬终点事件的风险较低（HR 0.08，95%CI 0.01-0.56；P=0.011）。
我们的结论是，T2DM 是 CAD 严重程度的独立预测因子，可通过病变血管数量、Gensini、SYNTAX、Jeopardy 评分和硬心血管终点来评估，这表明 T2DM 可进一步用于 HeFH 患者的风险分层。
