Watanabe Yukihiro, Yoshikawa Tsutomu, Arao Kenshiro, Isogai Toshiaki, Yamaguchi Tetsuo, Egashira Toru, Imori Yoichi, Mochizuki Hiroki, Yamamoto Takeshi, Asai Kuniya, Kohsaka Shun, Takayama Morimasa
Tokyo CCU Network Scientific Committee, Tokyo, Japan; Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan.
Tokyo CCU Network Scientific Committee, Tokyo, Japan.
Am J Cardiol. 2025 Feb 15;237:29-34. doi: 10.1016/j.amjcard.2024.11.022. Epub 2024 Nov 23.
Diabetes is a major risk factor for cardiovascular diseases. However, some reports have shown that diabetes has a low prevalence and is associated with favorable outcomes in takotsubo syndrome (TTS). This phenomenon, known as the "diabetes paradox," in which diabetes plays a protective role in the development of TTS, remains controversial. Therefore, we investigated the prevalence of diabetes and the prognostic impact of diabetes and glycemic control in patients with TTS. Using the Tokyo Cardiovascular Care Unit Network registry between 2015 and 2021, we identified 1,226 eligible patients with TTS (median age 77 years, male proportion 21%). The prevalence of diabetes, its clinical characteristics, and its association with in-hospital mortality were assessed. The prevalence of diabetes was 17.0% in TTS and 15.8% in the general population, with no significant difference (p = 0.445). Patients with diabetes were older and had higher body mass index, brain natriuretic peptide, and C-reactive protein levels than patients without diabetes. Patients with diabetes tended to have a higher in-hospital mortality rate than those without (6.3% vs 3.4%, p = 0.057). The multivariable analysis revealed that neither diabetes (odds ratio 1.83, 95% confidence interval 0.88 to 3.80, p = 0.106) nor hemoglobin A1c level was significantly associated with in-hospital mortality. In conclusion, diabetes is not uncommon and not a good prognostic factor in this multicenter registry. Our observations do not support a protective effect of diabetes on the emergence and outcomes of TTS.
糖尿病是心血管疾病的主要危险因素。然而，一些报告显示，糖尿病在应激性心肌病（TTS）中的患病率较低，且与良好预后相关。这种糖尿病在TTS发生过程中起保护作用的现象，即所谓的“糖尿病悖论”，仍然存在争议。因此，我们调查了TTS患者中糖尿病的患病率以及糖尿病和血糖控制对预后的影响。利用2015年至2021年东京心血管护理单元网络登记处的数据，我们确定了1226例符合条件的TTS患者（中位年龄77岁，男性比例21%）。评估了糖尿病的患病率、其临床特征及其与住院死亡率的关联。TTS患者中糖尿病的患病率为17.0%，普通人群中为15.8%，差异无统计学意义（p = 0.445）。糖尿病患者比非糖尿病患者年龄更大，体重指数、脑钠肽和C反应蛋白水平更高。糖尿病患者的住院死亡率往往高于非糖尿病患者（6.3%对3.4%，p = 0.057）。多变量分析显示，糖尿病（比值比1.83，95%置信区间0.88至3.80，p = 0.106）和糖化血红蛋白水平均与住院死亡率无显著关联。总之，在这个多中心登记处中，糖尿病并不罕见，也不是一个良好的预后因素。我们的观察结果不支持糖尿病对TTS的发生和预后有保护作用。
