糖尿病患者罹患腹主动脉瘤的风险因素。

IF 3.9 2区医学 Q1 PERIPHERAL VASCULAR DISEASE

Journal of Vascular Surgery Pub Date : 2025-01-01 Epub Date: 2024-09-18 DOI:10.1016/j.jvs.2024.09.007

In Young Cho, Kyungdo Han, Kyu Na Lee, Hye Yeon Koo, Yang Hyun Cho, Jun Ho Lee, Yang-Jin Park, Dong Wook Shin

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Increased AAA risk was observed for age ≥65 years (HR, 2.69; 95% CI, 2.55-2.83), men (HR, 1.81; 95% CI, 1.69-1.94), smoking (former smoker ≥20 pack-years [PY]; HR, 1.75; 95% CI, 1.61-1.89; current smoker <20 PY; HR, 1.76; 95% CI, 1.59-1.94; current smoker ≥20 PY; HR, 2.40; 95% CI, 2.23-2.59), abdominal obesity (HR, 1.30; 95% CI, 1.23-1.38), and comorbidities, including hypertension (HR, 1.63; 95% CI, 1.53-1.73), dyslipidemia (HR, 1.35; 95% CI, 1.29-1.42), chronic kidney disease (HR, 1.52; 95% CI, 1.44-1.61), and cardiovascular disease (HR, 1.71; 95% CI, 1.58-1.86). Heavy (HR, 0.67; 95% CI, 0.61-0.74) and mild alcohol consumption (HR, 0.78; 95% CI, 0.74-0.83), overweight (HR, 0.87; 95% CI, 0.81-0.93) and obesity (HR, 0.81; 95% CI, 0.75-0.87), longer diabetes duration (≥5 years: HR, 0.74; 95% CI, 0.70-0.78), and using three or more oral hypoglycemic agents (OHA) (HR, 0.84; 95% CI, 0.79-0.90) were associated with decreased AAA risk, whereas insulin use was associated with a marginally increased risk (HR, 1.09; 95% CI, 1.00-1.18). Among the OHAs, metformin (HR, 0.95; 95% CI, 0.90-1.00), thiazolidinediones (HR, 0.87; 95% CI, 0.79-0.97), and sulfonylureas (HR, 0.88; 95% CI, 0.83-0.93) were associated with a decreased risk of AAA.Conclusions: Although diabetes is associated with decreased AAA risk, those with comorbid cardiometabolic diseases, abdominal obesity, and a smoking history should be aware of an increased AAA risk. 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引用次数: 0

摘要

目的：尽管糖尿病与腹主动脉瘤（AAA）的发生呈负相关，但糖尿病患者仍有可能发生动脉瘤。在这项研究中，我们研究了糖尿病患者发生 AAA 的风险因素：方法：我们对 2009 年至 2012 年期间接受健康检查的 50 岁以上成人糖尿病患者的 AAA 病例进行了随访，直至 2019 年 12 月 31 日。采用Cox比例危险回归模型计算与AAA相关的风险因素的多变量危险比（HR）和95%置信区间（CI）：在1,913,066名参与者（55.3%为男性）中，在平均7.7年的随访中发现了6,996例AAA病例。观察到年龄≥65 岁（HR 2.69，95% CI 2.55-2.83）、男性（HR 1.81，95% CI 1.69-1.94）、吸烟（以前吸烟≥20 包年，HR 1.75，95% CI 1.61-1.89；现在吸烟<20 包年，HR 1.76，95% CI 1.59-1.94；现在吸烟≥20 包年，HR 2.40，95% CI 2.23-2.59）、腹部肥胖（HR 1.30，95% CI 1.23-1.38）和合并症：高血压（HR 1.63，95% CI 1.53-1.73）、血脂异常（HR 1.35，95% CI 1.29-1.42）、慢性肾病（HR 1.52，95% CI 1.44-1.61）、心血管疾病（HR 1.71，95% CI 1.58-1.86）。重度（HR 0.67，95% CI 0.61-0.74）和轻度饮酒（HR 0.78，95% CI 0.74-0.83）、超重（HR 0.87，95% CI 0.81-0.93）和肥胖（HR 0.81，95% CI 0.75-0.87）、糖尿病病程较长（≥5 年：HR 0.74，95% CI 0.70-0.78）和使用≥3种口服降糖药（HR 0.84，95% CI 0.79-0.90）与AAA风险降低有关，而使用胰岛素与风险略微增加有关（HR 1.09，95% CI 1.00-1.18）。在口服降糖药中，二甲双胍（HR 0.95，95% CI 0.90-1.00）、噻唑烷二酮（HR 0.87，95% CI 0.79-0.97）和磺脲类药物（HR 0.88，95% CI 0.83-0.93）与AAA风险降低有关：结论：虽然糖尿病与 AAA 风险的降低有关，但合并有心脏代谢疾病、腹部肥胖和吸烟史的患者应注意 AAA 风险的增加。需要进一步研究验证口服降糖药在降低 AAA 风险方面的潜在作用。

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Risk factors for abdominal aortic aneurysm in patients with diabetes.

Objective: Although diabetes has been shown to be negatively associated with development of abdominal aortic aneurysm (AAA), patients with diabetes may still develop aneurysms. In this study, we examined risk factors for the development of AAA in patients with diabetes.

Methods: Adults >50 years of age with diabetes who underwent health screening between 2009 and 2012 were followed for incident AAA until December 31, 2019. Cox proportional hazard regression models were used to calculate multivariate hazard ratios (HRs) and 95% confidence intervals (CIs) for risk factors associated with AAA.

Results: Among 1,913,066 participants (55.3% men), 6996 AAA cases were identified during a mean follow-up of 7.7 years. Increased AAA risk was observed for age ≥65 years (HR, 2.69; 95% CI, 2.55-2.83), men (HR, 1.81; 95% CI, 1.69-1.94), smoking (former smoker ≥20 pack-years [PY]; HR, 1.75; 95% CI, 1.61-1.89; current smoker <20 PY; HR, 1.76; 95% CI, 1.59-1.94; current smoker ≥20 PY; HR, 2.40; 95% CI, 2.23-2.59), abdominal obesity (HR, 1.30; 95% CI, 1.23-1.38), and comorbidities, including hypertension (HR, 1.63; 95% CI, 1.53-1.73), dyslipidemia (HR, 1.35; 95% CI, 1.29-1.42), chronic kidney disease (HR, 1.52; 95% CI, 1.44-1.61), and cardiovascular disease (HR, 1.71; 95% CI, 1.58-1.86). Heavy (HR, 0.67; 95% CI, 0.61-0.74) and mild alcohol consumption (HR, 0.78; 95% CI, 0.74-0.83), overweight (HR, 0.87; 95% CI, 0.81-0.93) and obesity (HR, 0.81; 95% CI, 0.75-0.87), longer diabetes duration (≥5 years: HR, 0.74; 95% CI, 0.70-0.78), and using three or more oral hypoglycemic agents (OHA) (HR, 0.84; 95% CI, 0.79-0.90) were associated with decreased AAA risk, whereas insulin use was associated with a marginally increased risk (HR, 1.09; 95% CI, 1.00-1.18). Among the OHAs, metformin (HR, 0.95; 95% CI, 0.90-1.00), thiazolidinediones (HR, 0.87; 95% CI, 0.79-0.97), and sulfonylureas (HR, 0.88; 95% CI, 0.83-0.93) were associated with a decreased risk of AAA.

Conclusions: Although diabetes is associated with decreased AAA risk, those with comorbid cardiometabolic diseases, abdominal obesity, and a smoking history should be aware of an increased AAA risk. Further studies are warranted to verify the potential use of OHAs for decreasing AAA risk.

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来源期刊

Journal of Vascular Surgery 医学-外科

CiteScore

7.70

自引率

18.60%

发文量

1469

审稿时长

54 days

期刊介绍： Journal of Vascular Surgery ® aims to be the premier international journal of medical, endovascular and surgical care of vascular diseases. It is dedicated to the science and art of vascular surgery and aims to improve the management of patients with vascular diseases by publishing relevant papers that report important medical advances, test new hypotheses, and address current controversies. To acheive this goal, the Journal will publish original clinical and laboratory studies, and reports and papers that comment on the social, economic, ethical, legal, and political factors, which relate to these aims. As the official publication of The Society for Vascular Surgery, the Journal will publish, after peer review, selected papers presented at the annual meeting of this organization and affiliated vascular societies, as well as original articles from members and non-members.