血浆低脂联素可预测冠脉钙化进展

脂联素(Adiponectin)是由脂肪细胞产生的一种胶原样蛋白合成物,循环中约占血浆总蛋白的0．01％左右。业已证实,循环内脂联素水平男性低于女性,且重度冠状动脉病、高血压、肥胖及2型糖尿病者亦低。然而关于低脂联素水平是否独立于其它心血管病诸公认危险因素可预测动脉粥样硬化进展程度迄今尚未清楚,本文就此进行了研究。     

高骨钙蛋白浓度降低腹主动脉钙化进展

腹主动脉钙化指数（AAC）是2型糖尿病等以胰岛素抵抗为特征的疾病的心血管风险的一个指标。AAC是成骨细胞分泌的一种可以增加胰岛素敏感性和胰岛素分泌的激素。为了确定老年人基线水平血清总骨钙蛋白与AAC进展及10年全因死亡率的关系，研究结果表明，     

胰岛素治疗妊娠期糖尿病的疗效及母婴风险研究

目的探讨胰岛素治疗妊娠期糖尿病的治疗效果与对母婴的影响。方法选取2010年9月—2014年2月来该院治疗妊娠期糖尿病患者180例,随机分为治疗组与对照组,对比两组临床治疗效果分析。结果治疗组效果明显优于对照组,差异有统计学意义(P<0.05);治疗组新生儿平均体重与对照组新生儿平均体重对比,差异无统计学意义(P>0.05);治疗组母婴并发症发生率跟对照组相比相差不大,差异无统计学意义(P>0.05)。结论适时使用胰岛素能有效治疗妊娠期糖尿病,有效避免母婴风险。     

2型糖尿病合并无症状冠状动脉钙化的相关危险因素分析

目的 分析2型糖尿病合并无症状冠状动脉钙化的危险因素.方法 选取2013年6月至2014年3月在大连医科大学附属二院住院治疗的2型糖尿病患者共199例作为研究对象.(1)根据患者有无胸闷、气短及与冠心病相关的异位疼痛等症状分为有症状组(89例)和无症状组(110例),颈部血管超声结果确定无症状组均有动脉硬化,两组均行冠状动脉CT检查.(2)根据冠状动脉钙化积分将有症状组与无症状组再分为钙化积分＞10分与钙化积分＜10分两个亚组.结果 (1)与有症状钙化积分＞10分组相比,无症状钙化积分＞10分组的体重指数、尿酸水平降低,尿微量白蛋白与尿肌酐比值(UACR)、高血压发生率、神经病变发生率较高(t=-1.990,-2.440,2.923,x2=4.459,10.941,P均＜0.05).(2)无症状钙化积分＜10分组平均糖尿病病程、年龄、UACR、高血压发生率、视网膜病变发生率、下肢动脉粥样硬化发生率明显小于无症状钙化积分＞10分组(t=-3.700,-3.440,-5.170,x2=4.880,6.761,4.951,P均＜0.05).(3)高龄、糖尿病病程长、UACR高的2型糖尿病患者发生无症状冠状动脉钙化的优势比(OR)值(95％CI)分别为1.059 (1.010～1.112),1.1 10 (1.021～1.207),1.009(1.000～1.019).结论 年龄、糖尿病病程、UACR是2型糖尿病合并无症状冠状动脉钙化异常的独立危险因素.     

冠脉钙化可有效预测老年人继后总死亡风险升高

冠脉钙化（CAC）业已逐渐被认为系罹发心血管疾病的独立预测因素之一。然而在老年人群中，关于CAC的预后价值尚未清楚。本文旨在就在老年人群中，伴CAC的实用预后价值进行了评价。     

胸腹部血管钙化可有效预测2型糖尿病和非糖尿病对象的心血管病死亡风险

众所周知，血管钙化常始发于代谢、机械、感染、炎性损伤等因素，推测其可能又与心血管病（CVD）并发症和死亡风险增加有关，尤其是在糖尿病患者和终末期肾病者。然而既往关于胸腹部血管钙化与2型糖尿病和非糖尿病对象继后CVD和总死亡风险间关系尚不清楚，现就此进行分析。     

年龄＜40岁与≥40岁新诊断2型糖尿病患者心血管病变风险比较

目的 比较年龄＜40岁与≥40岁新诊断T2DM患者心血管病变（CVD）危险因素水平及聚集情况. 方法 选取既往无冠心病病史的新诊断T2DM患者568例,分为年龄＜40岁组136例和年龄≥40岁组432例,收集一般资料和主要病史等,检测血糖、血脂、HbA1c、高敏C反应蛋白（hsC-RP）和24 hUAlb等指标. 结果 年龄＜40岁组BMI、BP、血糖、血脂、HbA1c、hsC-RP、24 hUAlb、吸烟、CVD家族史、肥胖/超重、BP升高、血脂异常、蛋白尿阳性率以及合并不同CVD危险因素数量的发生率与年龄≥40岁组比较差异无统计学意义,但血脂异常、BP升高的病情知晓率及治疗率低于年龄≥40岁组（P＜0.01）. 结论 年龄＜40岁与≥40岁新诊断T2DM患者具有相似的CVD发生风险,但前者病情知晓率及治疗率更低.     

2型糖尿病脂蛋白代谢及颗粒异常与心血管风险的研究进展

2007年至2008年我国糖尿病的流行病学调查显示中国糖尿病与糖尿病前期患病率分别高达9．7％和15．5％。糖尿病患者其脑血管疾病和卒中增加2-4倍,同时有80％的糖尿病患者死于心血管事件,每年有44％的成人终末期肾病由糖尿病肾病引起口0。有关流行病学调查结果显示,普通人群血脂异常的发生率为20％-40％,而糖尿病患者合并血脂异常者约占60％。并且我国流行病学研究资料还表明：血脂异常是冠心病发病的危险因素,其作用强度与西方人群相同;我国人群血清总胆固醇水平增高不仅增加冠心病发病危险,     

2型糖尿病患者踝肱指数与心血管危险因素的相关性研究

目的探讨2型糖尿病(T2DM)患者踝肱指数(ABI)与心血管危险因素的相关性。方法 87例T2DM患者根据ABI分为PAD组和非PAD组,进行病史回顾,体格检查,测定血脂、血压和糖化血红蛋白。结果 T2DM合并PAD组与非PAD组相比,年龄大,病程长,BMI、收缩压、舒张压、胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、HbA1c、FPG明显增高,多因素相关和回归分析显示,年龄、病程、BMI、收缩压、TC、LDL-C、HbAlc是影响ABI的独立危险因素。结论传统的心血管危险因素同样是加剧T2DM患者下肢动脉硬化的主要因素,应重视此类患者心血管危险的干预。     

“心血管风险综合防控策略”成为糖尿病治疗趋势

糖尿病、高血压、肥胖等都是心血管的危险因素。糖尿病患者要防止心血管病发生，必须综合控制这些危险因素，尤其重视降压。近日在京召开的“ADVANCE研究国际专家研讨会”上，来自澳大利亚的Bruce Neal教授介绍了降压治疗对糖尿病患者降低心血管风险的益处。     

Neither Diabetes nor Glucose-Lowering Drugs Are Associated With Mortality After Noncardiac Surgery in Patients With Coronary Artery Disease or Heart Failure

Background

It is unclear whether diabetes mellitus or use of particular glucose-lowering agents is associated with increased risk of mortality after noncardiac surgery in patients with known cardiac disease.

Methods

We carried out a retrospective cohort study using 4 linked administrative databases in the province of Alberta, Canada from 1999-2006.

Results

Of the 32,834 patients with known cardiac disease in our cohort, 9305 (28%) had diabetes. All-cause 30-day mortality after noncardiac surgery was 6.4% in patients with diabetes, and 6.1% in those without diabetes (multivariate adjusted odds ratio [aOR] 0.97, 95% confidence interval [CI], 0.87-1.08). In the 24,037 patients older than 65, mortality was 7.5% in individuals with diabetes and 7.5% in those without diabetes (5.7% in those taking insulin [aOR, 0.89; 95% CI, 0.70-1.13], 8.0% in those using oral agents only [aOR, 1.08; 95% CI, 0.95-1.22]). None of the glucose-lowering drug classes were associated with perioperative mortality in elderly cardiac patients (sulfonylureas aOR, 0.94; 95% CI, 0.76-1.16; metformin aOR, 0.92; 95% CI, 0.74-1.14; thiazolidinediones aOR, 0.64; 95% CI, 0.40-1.04; insulin aOR, 0.83; 95% CI, 0.65-1.08), but use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (aOR, 0.83; 95% CI, 0.75-0.93), β-blockers (aOR, 0.82; 95% CI, 0.72-0.93), or statins (aOR, 0.65; 95% CI, 0.55-0.78) in the 100 days before surgery were associated with lower 30-day mortality.

Conclusions

Neither diabetes nor exposure to common classes of glucose-lowering drugs preoperatively were associated with increased perioperative mortality in cardiac patients undergoing noncardiac surgery. However, cardiac patients not using angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, or statins preoperatively exhibited higher mortality rates, emphasizing the importance of optimizing evidence-based therapy before elective surgery in these patients.     

Lung Function Decline in Young Adulthood and Coronary Artery Calcium Progression in Midlife

BackgroundReduced lung function has been linked to cardiovascular disease, but population-based evidence on the relationship between lung function decline and coronary artery calcium (CAC) progression is rare.MethodsA total of 2694 participants (44.7% men) with a mean ± standard deviation age of 40.4 ± 3.6 years from the Coronary Artery Risk Development in Young Adults (CARDIA) were included. The rates of decline in forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) over a 20-year period were calculated for each participant and categorized into quartiles. The primary outcome was CAC progression.ResultsDuring a mean follow-up of 8.9 years, 455 (16.9%) participants had CAC progression. After adjusting for traditional cardiovascular risk factors, the hazard ratios (95% confidence intervals [CIs]) for CAC progression were higher for participants in the 2nd (Q2), 3rd (Q3), and highest quartiles (Q4) of FVC decline compared with those in the lowest quartile (Q1): 1.366 (1.003-1.861), 1.412 (1.035-1.927), and 1.789 (1.318-2.428), respectively. Similar trends were observed for the association between FEV1 and CAC progression. The association remained robust across a series of sensitivity analyses and all subgroups.ConclusionsA faster decline in FVC or FEV1 during young adulthood is independently associated with an increased risk of CAC progression in midlife. Maintaining optimal lung function during young adulthood may improve future cardiovascular health.     

Dietary Total Isoflavone Intake Is Associated With Lower Systolic Blood Pressure: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

The effect of dietary isoflavone intake on systolic blood pressure (SBP) has not been studied in a large community‐based cohort inclusive of African Americans. The authors analyzed data from the year 20 examination of the Coronary Artery Risk Development in Young Adults (CARDIA) study, including medical history, physical examination, and dietary intake surveys for 3142 participants. Multivariable linear regression models controlled for age, sex, body mass index, smoking, physical activity, and intakes of alcohol and total energy. Effect modification by race was tested. Overall, patients with hypertension had a lower daily intake of total dietary isoflavones (2.2±5.2 mg/d vs 4.1±11.7 mg/d; P<.001). In fully adjusted models, the highest quartile of dietary isoflavone intake was associated with a 4.4 mm Hg lower SBP on average compared with SBP for the lowest quartile. The relationship between dietary isoflavone intake and SBP was more pronounced among African Americans compared with Caucasians (P for interaction <.001). Greater dietary intake of isoflavones was independently associated with a lower SBP.     

Predicting Long-Term Absence of Coronary Artery Calcium in Metabolic Syndrome and Diabetes: The MESA Study

ObjectivesThe purpose of this study was to identify predictors of healthy arterial aging (long-term coronary artery calcification [CAC] of 0) among individuals with metabolic syndrome (MetS) or type 2 diabetes (T2D), which may improve primary prevention strategies.BackgroundIndividuals with MetS or T2D have a heterogeneously increased risk of atherosclerotic cardiovascular disease and not all have a high-intermediate risk.MethodsWe included 574 participants from the MESA (Multi-Ethnic Study of Atherosclerosis) with MetS or T2D who had CAC=0 at baseline and a repeat CAC scan 10 years later. Multivariable logistic regression assessed the association of traditional and novel atherosclerotic cardiovascular disease risk factors and the MetS severity score (based on the 5 MetS criteria) with healthy arterial aging.ResultsThe mean age of participants was 58.9 years, 67% were women, 422 participants had MetS, and 152 had T2D. The proportion with long-term CAC=0 was similar for MetS (42%) and T2D (44%). A younger age was the only individual low/normal traditional risk factor associated with an increased likelihood of long-term CAC=0 (odds ratio [OR]: 1.50; 95% confidence interval [CI]: 1.22 to 1.85 per 10-years younger). The strongest associations of nontraditional risk factors were observed for an absence of thoracic calcification (OR: 2.42; 95% CI: 1.24 to 4.72), absence of carotid plaque (OR: 1.81; 95% CI: 1.25 to 2.61), and among persons with a high sensitivity troponin <3 ng/ml (OR: 1.55; 95% CI: 1.01 to 2.38). In addition, persons with the lowest quartile MetS severity score had a substantially higher odds of healthy long-term CAC=0 (OR: 2.71; 95% CI: 1.27 to 5.76).ConclusionSMore than 40% of adults with MetS or T2D and baseline CAC=0 had long-term absence of CAC, which was most strongly associated with an absence of extracoronary atherosclerosis and a low MetS score. An optimal overall cardiovascular profile appears to be more important than an ideal value of any individual risk factor to maintain healthy arterial aging.     

妊娠期糖尿病患者血糖控制与妊娠结局的关系

目的 探究妊娠期糖尿病(GDM)患者血糖控制与妊娠结局的关系.方法 2017年12月—2019年12月间对该院65例GDM患者的病历资料做回顾性分析,并随机选取30名正常妊娠的孕妇作为健康对照组,GDM患者均给予常规治疗,依据血糖控制情况分为达标组及未达标组,血糖达标以美国糖尿病协会制定的血糖控制目标为标准,分别比较3...