2 型糖尿病患者和非 2 型糖尿病患者脚踝血压指数与主要不良心血管事件之间的关系。

IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Kamel Mohammedi, Marie Pigeyre, Jackie Bosch, Salim Yusuf, Hertzel C Gerstein
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引用次数: 0

摘要

背景:踝部血压(BP)与心血管疾病之间的关系仍不清楚。我们研究了已知的和新的踝关节血压指数与 2 型糖尿病患者和非 2 型糖尿病患者主要心血管结局之间的关系:我们使用了 3 项大型试验的数据,这些试验测量了踝关节收缩压(SBP)、踝肱指数(ABI,踝关节收缩压除以手臂收缩压)和踝脉压差(APPD,踝关节收缩压减去手臂脉压)。主要结果是心血管死亡、心肌梗死、心力衰竭住院或中风的综合结果。次要结果包括心血管原因导致的死亡、心肌梗死总数(致死和非致死)、心力衰竭住院治疗和中风总数:在 42929 名参与者(年龄 65.6 岁,女性占 31.3%,2 型糖尿病患者占 50.1%,53 个国家)中,有 7230 人(16.8%)在 5 年随访期间出现了主要结果(糖尿病患者占 19.4%,非糖尿病患者占 14.3%)。踝部血压指数越低,结果发生率越高。与踝关节血压指数处于最高四分位的患者相比,每降低四分之一,其结果的多变量调整危险比(HRs,95% CI)分别为 1.05(0.98-1.12)、1.17(1.踝SBP的HR分别为1.05(0.98-1.12)、1.17(1.08-1.25)和1.54(1.54-1.65);ABI的HR分别为1.06(0.99-1.14)、1.26(1.17-1.35)和1.48(1.38-1.58);APPD的HR分别为1.02(0.95-1.10)、1.15(1.07-1.23)和1.48(1.38-1.58)。踝部 SBP(HRs 1.05 [0.90-1.21]、1.21 [1.05-1.40]和 1.93 [1.68-2.22])和 APPD(HRs 1.08 [0.93-1.26]、1.30 [1.12-1.50]和 1.97 [1.72-2.25])对心力衰竭住院的影响最大,而对中风的影响则微乎其微。糖尿病患者和非糖尿病患者之间的关系相似(交互作用的 P 均大于 0.05):结论:踝部血压与心血管事件之间存在独立的反向关系,这一点在2型糖尿病患者和非2型糖尿病患者中都相似。心力衰竭的相关性最大,中风的相关性最小。在常规临床评估中纳入踝部血压指数可能有助于识别心血管事件的高危人群。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Relationships between ankle blood pressure indices and major adverse cardiovascular events in people with and without type 2 diabetes.

Background: The relationship between ankle blood pressure (BP) and cardiovascular disease remains unclear. We examined the relationships between known and new ankle BP indices and major cardiovascular outcomes in people with and without type 2 diabetes.

Methods: We used data from 3 large trials with measurements of ankle systolic BP (SBP), ankle-brachial index (ABI, ankle SBP divided by arm SBP), and ankle-pulse pressure difference (APPD, ankle SBP minus arm pulse pressure). The primary outcome was a composite of cardiovascular mortality, myocardial infarction, hospitalization for heart failure, or stroke. Secondary outcomes included death from cardiovascular causes, total (fatal and non-fatal) myocardial infarction, hospitalization for heart failure, and total stroke.

Results: Among 42,929 participants (age 65.6 years, females 31.3%, type 2 diabetes 50.1%, 53 countries), the primary outcome occurred in 7230 (16.8%) participants during 5 years of follow-up (19.4% in people with diabetes, 14.3% in those without diabetes). The incidence of the outcome increased with lower ankle BP indices. Compared with people whose ankle BP indices were in the highest fourth, multivariable-adjusted hazard ratios (HRs, 95% CI) of the outcome for each lower fourth were 1.05 (0.98-1.12), 1.17 (1.08-1.25), and 1.54 (1.54-1.65) for ankle SBP; HR 1.06 (0.99-1.14), 1.26 (1.17-1.35), and 1.48 (1.38-1.58) for ABI; and HR 1.02 (0.95-1.10), 1.15 (1.07-1.23), and 1.48 (1.38-1.58) for APPD. The largest effect size was noted for ankle SBP (HRs 1.05 [0.90-1.21], 1.21 [1.05-1.40], and 1.93 [1.68-2.22]), and APPD (HRs 1.08 [0.93-1.26], 1.30 [1.12-1.50], and 1.97 [1.72-2.25]) with respect to hospitalization for heart failure, while only a marginal association was observed for stroke. The relationships were similar in people with and without diabetes (all p for interaction > 0.05).

Conclusions: Inverse and independent associations were observed between ankle BP and cardiovascular events, similarly in people with and without type 2 diabetes. The largest associations were observed for heart failure and the smallest for stroke. Including ankle BP indices in routine clinical assessments may help to identify people at highest risk of cardiovascular outcomes.

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来源期刊
Cardiovascular Diabetology
Cardiovascular Diabetology 医学-内分泌学与代谢
CiteScore
12.30
自引率
15.10%
发文量
240
审稿时长
1 months
期刊介绍: Cardiovascular Diabetology is a journal that welcomes manuscripts exploring various aspects of the relationship between diabetes, cardiovascular health, and the metabolic syndrome. We invite submissions related to clinical studies, genetic investigations, experimental research, pharmacological studies, epidemiological analyses, and molecular biology research in this field.
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