Risk factors for and prognostic value of multifocal atherosclerosis in patients with diabetes mellitus


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AIM. To study the prognostic value of multifocal atherosclerosis (MFA) in patients with diabetes mellitus (DM) at high risk for myocardial ischemia who need coronary angiography (CAG). MATERIALS AND METHODS. The investigation included 148 patients: 25 with type 1 DM (DM1), 73 with type 2 DM (DM2), and 50 without DM who had undergone CAG. Duplex ultrasound scanning of lower limb vessels and brachiocephalic and renal arteries was carried out in all the patients. RESULTS. Involvement of two or more vascular beds was noted in 60% of the patients with DM1, in 68.4% of those with DM2, and in 34% of those without DM (p < 0.05). Regression analysis showed that the risk factors of MFA were defined to be myocardial infarction (MI) in the history (OR=2.4; p=0.02), DM (OR=3.9; p=0.0002), smoking (OR=2.4; p=0.05), elevated creatinine (OR=6.5; p=0.002) and fibrinogen (OR=6.8, p=0.004) levels. Among the DM patients, there were 26.5% of those who had achieved a main assessment criterion (a combined end point (CEP)), such as death, urgent hospitalization for heart failure, nonfatal MI, nonfatal stroke, lower extremity amputation, double creatinine levels, and achievement of end-stage renal failure during a 24-month follow-up. In patients without carbohydrate metabolic disturbances, this indicator was 12% (p=0.01). During the prospective study, a total of 6.1% of patients died in the DM group; all the patients in the non-DM group completed the study. Calculation of survival rates by the Kaplan-Meier method indicated that the DM patients with concurrent atherosclerotic lesion had achieved CEP significantly more frequently than the comparison group. Such differences were absent among the persons without carbohydrate metabolic disturbances. CONCLUSION. The regression analysis has shown that prior MI, DM, smoking, creatinine and fibrinogen levels are factors associated with the development of MFA in the examined groups. In the patients with DM, concurrent atherosclerosis of two or more vascular beds is an important factor for the progression of cardiovascular and renal diseases.

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Факторы риска и прогностическая значимость мультифокального атеросклероза у больных сахарным диабетом. - Резюме. Цель исследования. Изучить прогностическую значимость мультифокального атеросклероза (МФА) у больных сахарным диабетом (СД) с высоким риском развития ишемии миокарда, нуждающихся в коронарографии (КГ). Материалы и методы. В исследование включили 148 больных: 25 с СД 1-го типа (СД-1), 73 с СД 2-го типа (СД-2) и 50 - без СД, подвергшихся КГ. Всем пациентам проведено ультразвуковое дуплексное сканирование сосудов нижних конечностей, брахиоцефальных и почечных артерий. Результаты. Поражение 2 сосудистых бассейнов и более отмечено при СД-1 у 60% пациентов, при СД-2 у 68,4% пациентов, в группе без СД у 34% (р<0,05). По результатам регрессионного анализа факторами развития МФА определены инфаркт миокарда (ИМ) в анамнезе (ОШ 2,4; p=0,02), СД (ОШ 3,9; p=0,0002), курение (ОШ 2,4; p=0,05), повышение уровня креатинина (ОШ 6,5; p=0,002), фибриногена (ОШ 6,8, p=0,004). Среди пациентов с СД зарегистрировано 26,5% случаев достижения основного критерия оценки (конечной комбинированной точки - ККТ): смерть, срочная госпитализация по поводу сердечной недостаточности, нефатальный ИМ, нефатальный инсульт, ампутации нижних конечностей, удвоение уровня креатинина, достижение терминальной стадии почечной недостаточности в течение 24 мес наблюдения. У пациентов без нарушения углеводного обмена этот показатель составил 12% (р=0,01). Всего за время проспективного исследования в группе с СД умерли 6,1% пациентов, в группе лиц без СД все пациенты завершили исследование. Оценка выживаемости c помощью метода Каплана-Мейера показала, что больные СД с сочетанным атеросклеротическим поражением достигали ККТ значительно чаще, чем группа сравнения. Среди лиц без нарушения углеводного обмена подобных различий не было. Заключение. Факторами, ассоциированными с развитием МФА в исследуемых группах, по данным регрессионного анализа, являются перенесенный ИМ, СД, курение, уровень креатинина, фибриногена. Сочетанное атеросклеротическое поражение 2 сосудистых бассейнов и более у больных СД является значимым фактором прогрессирования сердечно-сосудистой и почечной патологии.
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