JACC：血糖升高或可直接损伤心脏
2012-02-11 MedSci MedSci原创
众所周知，随着高血糖症和糖尿病等代谢疾病的发展，患者罹患心脏病以及冠状动脉疾病的风险会大大增加。近日，Journal of the American College of Cardiology上收录的一篇研究论文表明：高血糖症导致心脏损害是一独立因素，即使患有高血糖症人不曾患有心脏病或是糖尿病，其心脏也会受到高血糖的影响。 该项研究的主要领导人--约翰霍普金斯彭博公共卫生学院的Elizabeth
众所周知，随着高血糖症和糖尿病等代谢疾病的发展，患者罹患心脏病以及冠状动脉疾病的风险会大大增加。近日，Journal of the American College of Cardiology上收录的一篇研究论文表明：高血糖症导致心脏损害是一独立因素，即使患有高血糖症人不曾患有心脏病或是糖尿病，其心脏也会受到高血糖的影响。
该项研究的主要领导人--约翰霍普金斯彭博公共卫生学院的Elizabeth Selvin博士带领科研人员开展了一项涉及9,662名有动脉粥样硬化风险的志愿者参与的跟踪研究。这些参与人员既不患冠心病，也不存在心力衰竭症状。
结果发现，患有心脏病的患者体内肌钙蛋白的水平较正常人要高出10倍多。并且肌钙蛋白的水平与糖化血红蛋白呈正相关。体内肌钙蛋白含量的多少与心脏病的发作有着密切联系，高水平的糖化血红蛋白会导致体内肌钙蛋白水平升高，长期以往血糖水平的升高可能导致了心脏的损害。
同时研究人员证实相比较于高血糖引发动脉粥样硬化，高血糖对心脏造成的影响更是一个独立因素。血糖水平的升高可能会直接造成心肌损伤。
研究人员表示也许糖尿病或是高血糖与心脏病之间可能存在其他潜在的联系。
Chronic hyperglycemia and subclinical myocardial injury
Rubin J, Matsushita K, Ballantyne CM, Hoogeveen R, Coresh J, Selvin E.
OBJECTIVES:
The purpose of this study was to examine the association between hyperglycemia and subclinical myocardial injury in persons without clinically evident coronary heart disease (CHD).
BACKGROUND:
Hyperglycemia is associated with an increased risk of cardiac events, but limited information is available on its relationship to subclinical myocardial damage. Elevated cardiac troponin T even below traditional detection levels can be detected by a novel high-sensitivity assay.
METHODS:
We examined the association between baseline glycated hemoglobin (HbA1c) and high-sensitivity cardiac troponin T (hs-cTnT) in 9,661 participants free of CHD and heart failure in the ARIC (Atherosclerosis Risk in Communities) study. Multivariable logistic regression models characterized the association between clinical categories of HbA1c (<5.7%, 5.7% to 6.4%, and ≥6.5%) and our primary outcome of elevated hs-cTnT (≥14 ng/l).
RESULTS:
Higher baseline values of HbA1c were associated in a graded fashion with elevated hs-cTnT (p for trend < 0.001). After adjusting for traditional risk factors, compared to persons with HbA1c <5.7%, the odds ratios of elevated hs-cTnT for persons with HbA1c 5.7% to 6.4% and ≥6.5% were 1.26 (95% confidence interval: 1.01 to 1.56) and 1.97 (95% confidence interval: 1.44 to 2.70), respectively.
CONCLUSIONS:
Higher HbA1c is associated with elevated hs-cTnT among persons without clinically evident CHD, suggesting that hyperglycemia contributes to myocardial injury beyond its effects on development of clinical atherosclerotic coronary disease
作者：MedSci
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