arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive League10.18705/1607-419X-2016-22-6-571-583arthyper-510Research ArticleЭПИДЕМИОЛОГИЧЕСКИЕ ИССЛЕДОВАНИЯEPIDEMIOLOGY STUDIESСердечно-лодыжечный сосудистый индекс и его связь с сахарным диабетом 2‑го типа и предиабетом по данным исследования ЭССЕ-РФ в Кемеровской областиCardio-ankle vascular index and its association with type 2 diabetes mellitus and pre-diabetes: the results of the ESSE-RF study in Kemerovskaya regionСуминА. Н.SuminA. N.

доктор медицинских наук, заведующий отделом мультифокального атеросклероза,

Сосновый бульвар, д. 6, Кемерово, 650002

MD, PhD, DSc, Chief, Department of Multifocal Atherosclerosis,

6 Sosnoviy bulvar, Kemerovo, 650002

БезденежныхН. А.BezdenezhnykhN. A.

научный сотрудник лаборатории патологии кровообращения отдела мультифокального атеросклероза,

Сосновый бульвар, д. 6, Кемерово, 650002

MD, PhD, Researcher, Laboratory of Circulation pathology,

6 Sosnoviy bulvar, Kemerovo, 650002

ФедороваН. В.FedorovaN. V.

научный сотрудник лаборатории патофизиологии мультифокального атеросклероза,

Сосновый бульвар, д. 6, Кемерово, 650002

MD, Researcher, Laboratory of Pathophysiology of Multifocal Atherosclerosis,

6 Sosnoviy bulvar, Kemerovo, 650002

БезденежныхА. В.BezdenezhnykhA. V.

кандидат медицинских наук, старший научный сотрудник реконструктивной хирургии мультифокального атеросклероза,

Сосновый бульвар, д. 6, Кемерово, 650002

MD, PhD, Senior Researcher, Laboratory of Reconstructive Surgery of Multifocal Atherosclerosis,

6 Sosnoviy bulvar, Kemerovo, 650002

ИндукаеваЕ. В.IndukaevaE. V.

кандидат медицинских наук, научный сотрудник лаборатории эпидемиологии сердечно-сосудистых заболеваний,

Сосновый бульвар, д. 6, Кемерово, 650002

MD, PhD, Researcher, Department of Epidemiology of Cardiovascular Diseases,

6 Sosnoviy bulvar, Kemerovo, 650002

АртамоноваГ. В.ArtamonovaG. V.

доктор медицинских наук, профессор, заместитель директора по научной работе, заведующая отделом оптимизации медицинской помощи при сердечно-сосудистых заболеваниях,

Сосновый бульвар, д. 6, Кемерово, 650002

MD, PhD, DSc, Professor, Deputy Director for Research, Сhief, Department of Medical Care Optimization in Cardiovascular Diseases,

6 Sosnoviy bulvar, Kemerovo, 650002

Федеральное государственное бюджетное научное учреждение «Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний»РоссияResearch Institute for Complex Issues of Cardiovascular DiseasesRussian Federation201610012017226571583Copyright © Сумин А.Н., Безденежных Н.А., Федорова Н.В., Безденежных А.В., Индукаева Е.В., Артамонова Г.В., 20172017Сумин А.Н., Безденежных Н.А., Федорова Н.В., Безденежных А.В., Индукаева Е.В., Артамонова Г.В.Sumin A.N., Bezdenezhnykh N.A., Fedorova N.V., Bezdenezhnykh A.V., Indukaeva E.V., Artamonova G.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://htn.almazovcentre.ru/jour/article/view/510

Цель исследования — оценить взаимосвязь предиабета и сахарного диабета (СД) с жесткостью артерий, оцененной посредством измерения сердечно-лодыжечного сосудистого индекса (СЛСИ).

Материалы и методы

Материалы и методы. Одномоментное исследование проведено в рамках многоцентрового эпидемиологического исследования «Эпидемиология сердечно-сосудистых заболеваний и их факторов риска в регионах Российской Федерации» (ЭССЕ-РФ) с марта по октябрь 2013 года. Объектом исследования явилась случайная популяционная выборка мужского и женского взрослого населения в возрасте 25–64 лет Кемеровской области. От каждого участника было получено письменное информированное согласие на проведение обследования. Стандартный протокол исследования ЭССЕ-РФ расширен дополнительным исследованием жесткости периферических артерий на аппарате VaSeraVS‑1000 (Fukuda Denshi, Япония) с автоматическим определением СЛСИ. В несколько этапов была сформирована выборка из 1619 человек, из нее исключены 2 пациента с СД 1‑го типа. Оставшиеся 1617 человек были разделены на три группы: группа 1 — пациенты с СД 2‑го типа (n = 272), группа 2 — пациенты с предиабетом — нарушением гликемии натощак, нарушением толерантности к глюкозе или их сочетанием (n = 44), группа 3 — лица без каких-либо подтвержденных нарушений углеводного обмена (n = 1301). Проанализированы клинико-анамнестические, лабораторные данные, показатели объемной сфигмографии (VaSera VS‑1000) в группах в зависимости от нарушений углеводного обмена.

Результаты

Результаты. В настоящем эпидемиологическом исследовании СД 2‑го типа выявлен у 16,6% обследованных, предиабет — в 2,7% случаев. При сравнении клинико-анамнестических и лабораторных характеристик обращает на себя внимание следующая тенденция: пациенты с СД и предиабетом были сравнимы по большинству показателей, но значимо отличались от пациентов без нарушений углеводного обмена. Это касалось распространенности ишемической болезни сердца, артериальной гипертензии, ожирения, инсульта, болезней почек, показателей липидного спектра. Значения СЛСИ у лиц с предиабетом и СД были выше (7,7 и 7,6), чем у лиц без нарушений углеводного обмена (7,2; р = 0,009 и р < 0,001). Частота выявления патологического СЛСИ (> 9,0) была выше среди пациентов с предиабетом иСД (15,9% и 16,8%) по сравнению с лицами с нормогликемией (9,0%, р < 0,001). По результату корреляционного анализа, проведенного в общей выборке, СЛСИ положительно коррелировал с возрастом (r = 0,526, р < 0,001), мужским полом (r = 0,111, р < 0,001), наличием СД 2‑го типа (r = 0,128, р < 0,001), предиабета (r = 0,071, р = 0,002), уровнем общего холестерина (r = 0,190, р < 0,001), триглицеридов (r = 0,108, р < 0,001), холестерина липопротеинов низкой плотности (r = 0,186, р < 0,001), мочевой кислоты (r = 0,085, р < 0,001). СЛСИ отрицательно коррелировал со скоростью клубочковой фильтрации CKD-EPI (r = –0,461, р < 0,001). По результату регрессионного анализа значения СЛСИ были ассоциированы как с наличием СД (отношение шансов (ОШ) 1,18595%, доверительный интервал (ДИ) 1,100–1,276; p < 0,001), так и предиабета (ОШ 1,179 95% ДИ 1,008–1,380; р = 0,05).

Заключение

Заключение. Предиабет в такой же степени, как и СД 2‑го типа, ассоциирован с факторами сердечно-сосудистого риска, в том числе с повышенной жесткостью артерий. Увеличение СЛСИ в популяционной выборке Западной Сибири ассоциировано как с СД 2‑го типа, так и с предиабетом.

Objective

Objective. To evaluate the relationship of pre-diabetes and diabetes mellitus (DM) with arterial stiffness assessed by cardio-ankle vascular index (CAVI).

Design and methods

Design and methods. Cross-sectional study in the framework of a multicenter epidemiological study “Epidemiology of cardiovascular diseases and their risk factors in the Russian Federation” (ESSE-RF) from March to October 2013. The object of the study was a random population sample of the Kemerovo region of males and females aged 25–64 years. Each participant provided written informed consent to the survey. Standard research protocol ESSE-RF extended by further study of peripheral arterial stiffness using VaSeraVS‑1000 (Fukuda Denshi, Japan) with automatic measurement of CAVI. The CAVI ≥ 9,0 was considered as pathological. Two patients with type 1 DM were excluded from a total sample of 1619 people. The remaining 1617 people were divided into three groups: Group 1 — patients with type 2 DM (n = 272), Group 2 — patients with prediabetes — impaired fasting glucose, impaired glucose tolerance or their combination (n = 44), Group 3 — persons without any confirmed carbohydrate metabolism disorder (n = 1301). Medical history and laboratory data and indicators of volume sphygmography (VaSera VS‑1000) were analyzed in groups depending on the presence of carbohydrate metabolism disorders.

Results

Results. The type 2 DM was diagnosed in 16,6% patients, pre-diabetes — in 2,7%. Patients with DM and prediabetes were comparable for most indicators, but significantly different from patients without carbohydrate metabolism disorders. The prevalence of coronary heart disease, hypertension, obesity, stroke, kidney disease, dyslipidemia was higher among DM and pre-diabetic patients. The CAVI in patients with pre-diabetes and DM were higher (7,7 and 7,6) than in those without the carbohydrate metabolism disorders (7,2; p = 0,009 and p < 0,001, respectively). The incidence of pathologic CAVI (> 9,0) was higher among patients with DM and prediabetes (15,9% and 16,8%) compared with those with normoglycaemia (9,0%, p < 0,001 for trend). The CAVI positively correlated with age (r = 0,526, p < 0,001), male gender (r = 0,111, p < 0,001), type 2 DM (r = 0,128, p < 0,001), prediabetes (r = 0,071, p = 0,002), total cholesterol (r = 0,190, p < 0,001), triglycerides (r = 0,108, p < 0,001), low-density lipoprotein cholesterol (r = 0,186, p < 0,001), uric acid (r = 0,085, p < 0,001). The CAVI negatively correlated with the glomerular filtration rate GFR CKD-EPI (r = –0,461, p < 0,001). The regression analysis showed that CAVI values were associated with the presence of DM (odds ratio (OR) 1,185 with an increase in the CAVI for each unit, 95% confidence interval (CI) 1,100–1,276; p < 0,001), and pre-diabetes (OR 1,179, 95% CI 1,008–1,380; p = 0,044).

Conclusions

Conclusions. Prediabetic and DM patients have similar prevalence of cardiovascular risk factors, including increased stiffness of arteries. In a community sample of Western Siberia increase in CAVI was associated with both type 2 DM and prediabetes.

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The authors declare that there are no conflicts of interest present.