Lee M, Gardin J M, Lynch J C, Smith V E, Tracy R P, Savage P J, Szklo M, Ward B J
Department of General Medicine, University of California, Davis, USA.
Am Heart J. 1997 Jan;133(1):36-43. doi: 10.1016/s0002-8703(97)70245-x.
This report describes the relation among diabetes, blood pressure, and prevalent cardiovascular disease, and echocardiographically measured left ventricular mass and filling (transmitral valve flow) velocities in the Cardiovascular Health Study, a cohort of 5201 men and women > or = 65 years of age. Ventricular septal and left posterior wall thicknesses were greater in diabetic than in nondiabetic subjects, showing a significant linear trend (p = 0.025 for ventricular septal thickness in both sexes combined, p = 0.002 for posterior wall thickness) with increased duration of diabetes. Increased wall thickness of the ventricular septum or the left posterior wall was not associated with prevalent coronary heart disease (CHD) in the cohort. Increased left ventricular mass was associated with diabetic persons not reporting CHD and with all subjects with CHD regardless of glucose tolerance status. After adjusting for body weight, blood pressure, heart rate, and prevalent coronary or cerebrovascular disease, diabetes (as measured by glucose level, insulin use, oral hypoglycemic use, and a positive history of diabetes before baseline examination) remained an independent predictor of increased left ventricular mass among men and women (174.2 gm in diabetic men vs 169.8 gm in normal men, 138.2 gm in diabetic women vs 134.0 gm in normal women, p = 0.043 for both sexes combined). Both early and late diastolic transmitral peak flow velocities were higher with increased duration of diabetes, but the calculated ratio of the early peak flow velocity to the late velocity (E/A ratio) did not differ significantly between subjects with historical diabetes and those with normal fasting glucose (both genders combined, p = 0.190). Glucose level, insulin use, oral hypoglycemic use, and a positive history of diabetes before baseline examination were significant independent predictors of the late transmitral peak flow velocity and its integrated flow-velocity curve but not for the integral of the early peak flow velocity or the E/A ratio. Diabetes is associated with abnormal left ventricular structure and function in elderly persons. This association persists after adjustment for body weight, blood pressure, heart rate, and reported coronary or cerebrovascular disease.
本报告描述了心血管健康研究中糖尿病、血压与心血管疾病患病率之间的关系，以及通过超声心动图测量的左心室质量和充盈（经二尖瓣血流）速度。该研究队列包含5201名年龄≥65岁的男性和女性。糖尿病患者的室间隔和左后壁厚度大于非糖尿病患者，且随着糖尿病病程延长呈现显著的线性趋势（男女合并室间隔厚度p = 0.025，后壁厚度p = 0.002）。在该队列中，室间隔或左后壁厚度增加与冠心病（CHD）患病率无关。左心室质量增加与未报告冠心病的糖尿病患者以及所有冠心病患者相关，无论其糖耐量状态如何。在调整体重、血压、心率以及冠心病或脑血管疾病患病率后，糖尿病（通过血糖水平、胰岛素使用情况、口服降糖药使用情况以及基线检查前糖尿病阳性病史衡量）仍是男性和女性左心室质量增加的独立预测因素（糖尿病男性为174.2克，正常男性为169.8克；糖尿病女性为138.2克，正常女性为134.0克，男女合并p = 0.043）。随着糖尿病病程延长，舒张期早期和晚期经二尖瓣血流峰值速度均升高，但有糖尿病病史的受试者与空腹血糖正常的受试者之间，早期峰值流速与晚期流速的计算比值（E/A比值）无显著差异（男女合并，p = 0.190）。血糖水平、胰岛素使用情况、口服降糖药使用情况以及基线检查前糖尿病阳性病史是晚期经二尖瓣血流峰值速度及其积分流速曲线的显著独立预测因素，但不是早期峰值流速积分或E/A比值的预测因素。糖尿病与老年人左心室结构和功能异常相关。在调整体重、血压、心率以及报告的冠心病或脑血管疾病后，这种关联仍然存在。
