青年起病 2 型糖尿病患者的动脉僵硬度与心脏结构和功能的后续变化关系：来自 TODAY 研究的结果。
Relationship between Arterial Stiffness and Subsequent Cardiac Structure and Function in Young Adults with Youth-Onset Type 2 Diabetes: Results from the TODAY Study.
机构信息
Department of Pediatrics, Cincinnati Children's Hospital and University of Cincinnati, Cincinnati, Ohio.
Geisinger Genomic Medicine Institute, Danville, Pennsylvania.
出版信息
J Am Soc Echocardiogr. 2022 Jun;35(6):620-628.e4. doi: 10.1016/j.echo.2022.02.001. Epub 2022 Feb 8.
BACKGROUND
Higher arterial stiffness may contribute to future alterations in left ventricular systolic and diastolic function. We tested this hypothesis in individuals with youth-onset type 2 diabetes from the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study.
METHODS
Arterial stiffness (pulse wave velocity [carotid-femoral, femoral-foot, and carotid-radial], augmentation index, brachial distensibility) was measured in 388 participants with type 2 diabetes (mean age, 21 years; diabetes duration, 7.7 ± 1.5 years). To reflect overall (composite) vascular stiffness, the five arterial stiffness measures were aggregated. An echocardiogram was performed in the same cohort 2 years later. Linear regression models assessed whether composite arterial stiffness was associated with left ventricular mass index or systolic and diastolic function, independent of age, sex, race/ethnicity, current cigarette smoking, and long-term exposure (time-weighted mean values over 9.1 years) of hemoglobin A1c, blood pressure, and body mass index. Interactions among arterial stiffness and time-weighted mean hemoglobin A1c, blood pressure, and body mass were also examined.
RESULTS
After adjustment, arterial stiffness remained significantly associated with left ventricular mass index and diastolic function measured by mitral valve E/Em, despite attenuation by time-weighted mean body mass index. A significant interaction revealed a greater adverse effect of composite arterial stiffness on mitral valve E/Em among participants with higher levels of blood pressure over time. Arterial stiffness was unrelated to left ventricular systolic function.
CONCLUSIONS
The association of higher arterial stiffness with future left ventricular diastolic dysfunction suggests the path to future heart failure may begin early in life in this setting of youth-onset type 2 diabetes.
TRIAL REGISTRATION
ClinicalTrials.gov NCT00081328.
背景
较高的动脉僵硬度可能导致左心室收缩和舒张功能的未来改变。我们在来自青少年 2 型糖尿病治疗选择（TODAY）研究的青年起病 2 型糖尿病个体中检验了这一假说。
方法
在 388 例 2 型糖尿病患者（平均年龄 21 岁；糖尿病病程 7.7±1.5 年）中测量了动脉僵硬度（脉搏波速度[颈动脉-股动脉、股动脉-足背动脉、颈动脉-桡动脉]、增强指数、肱动脉顺应性）。为了反映整体（综合）血管僵硬度，将五种动脉僵硬度测量值进行了汇总。同一队列在 2 年后进行了超声心动图检查。线性回归模型评估了综合动脉僵硬度与左心室质量指数或收缩和舒张功能之间的关系，独立于年龄、性别、种族/民族、当前吸烟以及血红蛋白 A1c、血压和体重指数的长期暴露（9.1 年的时间加权平均值）。还检验了动脉僵硬度与时间加权平均血红蛋白 A1c、血压和体重之间的交互作用。
结果
调整后，尽管时间加权平均体重指数减弱了，但动脉僵硬度仍与左心室质量指数和二尖瓣 E/Em 测量的舒张功能显著相关。一项显著的交互作用表明，在随时间升高的血压水平较高的参与者中，综合动脉僵硬度对二尖瓣 E/Em 的不良影响更大。动脉僵硬度与左心室收缩功能无关。
结论
较高的动脉僵硬度与未来左心室舒张功能障碍的相关性表明，在这种青年起病 2 型糖尿病的情况下，未来心力衰竭的发生途径可能很早就开始了。
试验注册
ClinicalTrials.gov NCT00081328。
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