不同糖代谢异常阶段的动脉僵硬度与冠状动脉亚临床动脉粥样硬化。
Arterial stiffness and subclinical atherosclerosis in the coronary arteries at different stages of dysglycaemia.
作者信息
Cederqvist John, Rådholm Karin, Muhammad Iram Faqir, Engström Gunnar, Engvall Jan, Östgren Carl Johan
机构信息
Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
Department of Clinical Science, Lund University, Malmö, Sweden.
出版信息
Diabet Med. 2023 Jul;40(7):e15102. doi: 10.1111/dme.15102. Epub 2023 Apr 8.
AIM
Our aim was to investigate in a large population-based cohort study whether increased arterial stiffness and subclinical atherosclerosis in the coronary arteries differ at different stages of dysglycaemia.
METHODS
Data were obtained from SCAPIS, a population-based cohort of participants 50-64 years. The study population of 9379 participants was categorised according to glycaemic status: normoglycaemic, pre-diabetes (fasting glucose: 6.1-6.9 mmol/L and/or HbA1c 6%-6.4%) and diabetes. Pulse wave velocity (PWV) was measured by the SphygmoCor XCEL system and arterial stiffness was defined by PWV ≥10 m/s. Coronary artery calcium score (CACS) was assessed by coronary computed tomography and coronary artery calcification was defined by CACS ≥100.
RESULTS
We identified 1964 (21%) participants with dysglycaemia, out of which 742 (7.9%) had diabetes mellitus. PWV ≥10 m/s was present in 808 (11%), 191 (16%), 200 (27%) and CACS ≥100 in 801 (11%), 190 (16%), 191 (28%) participants with normoglycaemia, pre-diabetes and diabetes, respectively, all, p < 0.001. The overlap between PWV ≥10 m/s and CACS ≥100 within each glycaemic category was 188 (2.5%), 44 (3.6%) and 77 (10) respectively. There was an association between glycaemic status and increased PWV in the fully adjusted models, but not for glycaemic status and CACS ≥100, where there was no difference for pre-diabetes compared to normoglycaemia, OR 1.2 (95% CI 0.98-1.4). In the total study population, there was an association between HbA1c and PWV after adjustment, p < 0.001.
CONCLUSIONS
Our results show that increased arterial stiffness and subclinical coronary artery atherosclerosis are present in the early stages of dysglycaemia, but the overlap between markers of major subclinical vascular damage was small in all glycaemic categories. This could be explained by different pathways in the pathogenesis of arterial stiffness or atherosclerosis in the coronary arteries.
目的
我们旨在通过一项大型基于人群的队列研究，探究在不同糖代谢异常阶段，动脉僵硬度和冠状动脉亚临床动脉粥样硬化的变化是否存在差异。
方法
数据来自基于人群的 SCAPIS 研究队列，纳入 50-64 岁的参与者。研究人群共 9379 名参与者，根据血糖状态分类：血糖正常（空腹血糖：6.1-6.9mmol/L 和/或糖化血红蛋白 6%-6.4%）、糖尿病前期（空腹血糖：6.1-6.9mmol/L 和/或糖化血红蛋白 6%-6.4%）和糖尿病。脉搏波速度（PWV）采用 SphygmoCor XCEL 系统进行测量，动脉僵硬度定义为 PWV≥10m/s。冠状动脉钙评分（CACS）采用冠状动脉计算机断层扫描进行评估，冠状动脉钙化定义为 CACS≥100。
结果
我们发现 1964 名（21%）参与者存在糖代谢异常，其中 742 名（7.9%）患有糖尿病。PWV≥10m/s 分别见于血糖正常、糖尿病前期和糖尿病参与者中的 808 名（11%）、191 名（16%）和 200 名（27%），CACS≥100 分别见于血糖正常、糖尿病前期和糖尿病参与者中的 801 名（11%）、190 名（16%）和 191 名（28%），差异均有统计学意义（均 P<0.001）。在每个糖代谢类别中，PWV≥10m/s 和 CACS≥100 之间的重叠分别为 188 名（2.5%）、44 名（3.6%）和 77 名（10%）。在完全调整的模型中，糖代谢状态与 PWV 增加之间存在关联，但糖代谢状态与 CACS≥100 之间无关联，糖尿病前期与血糖正常者相比，比值比（OR）为 1.2（95%可信区间：0.98-1.4）。在整个研究人群中，HbA1c 与 PWV 之间存在关联，经校正后 P<0.001。
结论
我们的研究结果表明，在糖代谢异常的早期阶段，动脉僵硬度和冠状动脉亚临床动脉粥样硬化均有增加，但在所有糖代谢类别中，主要亚临床血管损伤标志物之间的重叠较小。这可能是由于动脉僵硬度或冠状动脉粥样硬化的发病机制不同所致。
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