Planas Alejandra, Simó-Servat Olga, Hernández Cristina, Ortiz-Zúñiga Ángel, Marsal Joan Ramón, Herance José R, Ferreira-González Ignacio, Simó Rafael
Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Autonomous University of Barcelona, 08035 Barcelona, Spain.
CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spanish Institute of Health (ISCIII), 28029 Madrid, Spain.
J Pers Med. 2021 Dec 10;11(12):1344. doi: 10.3390/jpm11121344.
Risk of cardiovascular events is not homogeneous in subjects with type 2 diabetes; therefore, its early identification remains a challenge to be met. The aim of this study is to evaluate whether the presence of diabetic retinopathy and accumulation of advanced glycation end-products in subcutaneous tissue can help identify patients at high risk of cardiovascular events. For this purpose, we conducted a prospective study (mean follow-up: 4.35 years) comprising 200 subjects with type 2 diabetes with no history of clinical cardiovascular disease and 60 non-diabetic controls matched by age and sex. The primary outcome was defined as the composite of myocardial infarction, coronary revascularization, stroke, lower limb amputation or cardiovascular death. The Cox proportional hazard multiple regression analysis was used to determine the independent predictors of cardiovascular events. The patients with type 2 diabetes had significantly more cardiovascular events than the non-diabetic subjects. Apart from the classic factors such as age, sex and coronary artery calcium score, we observed that the diabetic retinopathy and advanced glycation end-products in subcutaneous tissue were independent predictors of cardiovascular events. We conclude that the diabetic retinopathy and advanced glycation end-products in subcutaneous tissue could be useful biomarkers for selecting type 2 diabetic patients in whom the screening for cardiovascular disease should be prioritized, thereby creating more personalized and cost-effective medicine.
2型糖尿病患者发生心血管事件的风险并不相同；因此，早期识别仍是一项有待应对的挑战。本研究的目的是评估糖尿病视网膜病变的存在以及皮下组织中晚期糖基化终产物的积累是否有助于识别心血管事件高危患者。为此，我们进行了一项前瞻性研究（平均随访时间：4.35年），纳入了200例无临床心血管疾病史的2型糖尿病患者以及60例按年龄和性别匹配的非糖尿病对照者。主要结局定义为心肌梗死、冠状动脉血运重建、中风、下肢截肢或心血管死亡的复合事件。采用Cox比例风险多元回归分析来确定心血管事件的独立预测因素。2型糖尿病患者发生心血管事件的次数显著多于非糖尿病受试者。除了年龄、性别和冠状动脉钙化积分等经典因素外，我们观察到糖尿病视网膜病变和皮下组织中的晚期糖基化终产物是心血管事件的独立预测因素。我们得出结论，糖尿病视网膜病变和皮下组织中的晚期糖基化终产物可能是有用的生物标志物，可用于筛选应优先进行心血管疾病筛查的2型糖尿病患者，从而创造更具个性化和成本效益的医疗方案。
