心, 脳, 下肢の糖尿病マクロアンギオパチーの臨床的特徴と生命予後

抄録

Cross-sectional studies of cardiac, cerebral and peripheral macroangiopathy (MA) were conducted in 842 subjects with type-2 diabetes. Prevalence of ischemic heart disease (IHD), cerebral infarction (CI) and arteriosclerosis obliterans (ASO) was 33.8, 31.9 and 10.5%, respectively. Although half of the diabetic subjects had at least one of these MA, many cases were clinically asymptomatic. Most of the subjects complicated with ASO had IHD and/or CI, suggesting that ASO may serve as an index for advanced systemic atherosclerosis. Multivariate analysis indicated aging, duration of diabetes, co-existance of hypertension and low HDLcholesterol as common risk factors of these 3 MA. In addition, high total cholesterol levels and smoking could be independent risk factors of IHD and ASO, respectively. Diabetic MA, especially ASO, tended to associate with endstage renal disease and autonomic neuropathy. The degree of MA which complicated was closely correlated with the mortality rate. The mortality rate of subjects with all 3 MA surpassed that of MA-free cases by 21 fold. These data suggest that evaluation of MA using noninvasive approach is important for subjects with longstanding diabetes and/or advanced microangiopathy.