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在长期1型糖尿病患者中,冠状动脉样硬化和心肌功能障碍的风险和保护因素
Marc Gregory Yu1,2, Hetal Shah1,2, Surya Jangolla1,2
1Dianne Nunnally Hoppes Laboratory, Research Division, Joslin Diabetes Center, Boston, MA, USA.
Diabetologia
|August 19, 2025
概括
长期患有1型糖尿病但没有脏疾病的人仍然面临高心血管疾病 (CVD) 风险. 控制血糖和炎症,特别是骨质疏松素,可能会减少这一群体中的心血管疾病.
科学领域:
- 心脏病学 心脏病学
- 内分泌学 在内分泌学.
- 糖尿病学 糖尿病学
背景情况:
- 心血管疾病 (CVD) 是长期1型糖尿病患者死亡的主要原因,即使没有糖尿病病 (DKD).
- 约斯林"奖牌获得者"队列,包括患有1型糖尿病≥50年的个体,提供了一个独特的人群来研究心血管疾病风险.
研究的目的:
- 评估长期1型糖尿病患者中与心血管疾病风险相关的生物标志物,重点关注没有DKD的人.
- 调查血糖控制,炎症标志物和心血管疾病,冠状动脉 (CAC) 和心磁共振 (CMR) 发现之间的关系.
主要方法:
- 一项涉及1038名自我报告心血管疾病的参与者的横截面研究,其中的子集接受了CAC (n=142) 和CMR (n=111) 成像.
- 用多变量回归分析来检查循环因子 (包括炎症生物标志物和骨质素),血糖标志物 (HbA1c,持续血糖监测,高级糖化最终产品) 和心血管疾病结果之间的关联,调整DKD和其他危险因素.
主要成果:
- 尽管心脏代谢管理很好,但40%的参与者患有心血管疾病和高CAC负担,无论DKD状态如何.
- 在非DKD组中,HbA1c仍然与心血管疾病相关 (OR 1.40),而低血糖和血糖变异性则没有.
- 在非DKD组中,骨质松丁与心血管疾病有显著的关联 (β=0.50),突出了其潜在的作用.
结论:
- 长期患有1型糖尿病且没有DKD的个体,即使心脏代谢控制良好,也会出现大量的冠状动脉样硬化.
- 改善高血糖和降低炎症的策略,特别是针对骨质素,可能对管理这一群体中心血管疾病风险至关重要.
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