Wagenknecht L E, D'Agostino R, Savage P J, O'Leary D H, Saad M F, Haffner S M
Department of Public Health Sciences, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC 27157, USA.
Stroke. 1997 May;28(5):999-1005. doi: 10.1161/01.str.28.5.999.
Diabetes is a major risk factor for morbidity and mortality from cardiovascular disease. However, the role of the primary metabolic abnormality of diabetes (chronic hyperglycemia) in this disease process has not been fully elucidated.
A cross-sectional analysis was conducted among 489 persons with non-insulin-dependent diabetes mellitus; 299 were established diabetics (diagnosed previously) and 190 were newly diagnosed at the time of the Insulin Resistance Atherosclerosis Study (IRAS) examination. These men and women, of three different ethnic groups, were participants in IRAS. Established diabetes (versus newly diagnosed diabetes) and mean fasting glucose level were used as measures of hyperglycemic burden. Intimal-medial wall thickness (IMT) of the internal (ICA) and common (CCA) carotid arteries were used as indices of atherosclerosis.
The mean duration of disease among established diabetics was 7 years. The mean CCA IMT and ICA IMT were 872 and 946 microns, respectively. Established diabetes and mean fasting glucose level were positively associated with increased CCA IMT (P < .05) but not ICA IMT, even after adjustment for numerous cardiovascular disease risk factors. CCA IMT was increased by 70 microns in established diabetics (versus newly diagnosed diabetics) and by 26 microns per 1 SD of fasting glucose. Among established diabetics, however, duration of known diabetes (number of years) was not significantly related to IMT.
Among diabetics in IRAS, established diabetes and fasting glucose level were each independently associated with CCA IMT, suggesting that chronic hyperglycemia or its associated metabolic abnormalities may lead to increased risk of atherosclerosis.
糖尿病是心血管疾病发病和死亡的主要危险因素。然而，糖尿病的主要代谢异常（慢性高血糖）在这一疾病过程中的作用尚未完全阐明。
对489例非胰岛素依赖型糖尿病患者进行了横断面分析；299例为已确诊糖尿病患者（先前已诊断），190例在胰岛素抵抗动脉粥样硬化研究（IRAS）检查时新诊断。这些来自三个不同种族的男性和女性是IRAS的参与者。已确诊糖尿病（与新诊断糖尿病相比）和平均空腹血糖水平用作高血糖负担的衡量指标。颈内动脉（ICA）和颈总动脉（CCA）的内膜中层厚度（IMT）用作动脉粥样硬化的指标。
已确诊糖尿病患者的平均病程为7年。平均CCA IMT和ICA IMT分别为872微米和946微米。即使在调整了众多心血管疾病危险因素之后，已确诊糖尿病和平均空腹血糖水平与CCA IMT增加呈正相关（P <.05），但与ICA IMT无关。已确诊糖尿病患者（与新诊断糖尿病患者相比）的CCA IMT增加70微米，空腹血糖每增加1个标准差，CCA IMT增加26微米。然而，在已确诊糖尿病患者中，已知糖尿病的病程（年数）与IMT无显著相关性。
在IRAS的糖尿病患者中，已确诊糖尿病和空腹血糖水平均与CCA IMT独立相关，提示慢性高血糖或其相关的代谢异常可能导致动脉粥样硬化风险增加。
