Importance of cardiovascular disease risk management in patients with type 2 diabetes mellitus.
Importance of cardiovascular disease risk management in patients with type 2 diabetes mellitus.
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DOI：
10.2147/dmso.s61438
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发表时间：
2014
期刊：
影响因子：
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通讯作者：
Lorber D
中科院分区：
文献类型：
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作者：
Lorber D
2型糖尿病（T2 DM）通常伴有其他心血管疾病（CVD）风险因素，如高血压、肥胖和血脂异常。此外，CVD是T2 DM患者最常见的死亡原因。因此，通过谨慎管理T2 DM患者中可改变的CVD风险因素，最大限度地降低大血管并发症的风险至关重要。治疗策略应包括针对高血糖、高血压、血脂异常、肥胖、吸烟、缺乏运动和促血栓形成因素的生活方式和药物干预。本文讨论了在T2 DM背景下修改这些CVD风险因素的影响;总结了临床证据，并讨论了当前指南。戒烟、增加体力活动、降低低密度脂蛋白胆固醇和血压对心血管的益处是众所周知的。对于阿司匹林治疗，任何心血管益处都必须与相关的出血风险相平衡，目前的证据仅在某些CVD风险增加的患者中支持这种策略。尽管超重、肥胖和高血糖与心血管风险增加明显相关，但现有临床试验证据对这些改变对心血管风险的影响尚不清楚。然而，对于降糖药物，预计将从几项正在进行的心血管结局试验中获得进一步的证据。总之，证据强调了早期干预的价值，并通过生活方式和药理学策略针对多种风险因素，以提供长期减少大血管并发症的最佳机会。
Type 2 diabetes mellitus (T2DM) is commonly accompanied by other cardiovascular disease (CVD) risk factors, such as hypertension, obesity, and dyslipidemia. Furthermore, CVD is the most common cause of death in people with T2DM. It is therefore of critical importance to minimize the risk of macrovascular complications by carefully managing modifiable CVD risk factors in patients with T2DM. Therapeutic strategies should include lifestyle and pharmacological interventions targeting hyperglycemia, hypertension, dyslipidemia, obesity, cigarette smoking, physical inactivity, and prothrombotic factors. This article discusses the impact of modifying these CVD risk factors in the context of T2DM; the clinical evidence is summarized, and current guidelines are also discussed. The cardiovascular benefits of smoking cessation, increasing physical activity, and reducing low-density lipoprotein cholesterol and blood pressure are well established. For aspirin therapy, any cardiovascular benefits must be balanced against the associated bleeding risk, with current evidence supporting this strategy only in certain patients who are at increased CVD risk. Although overweight, obesity, and hyperglycemia are clearly associated with increased cardiovascular risk, the effect of their modification on this risk is less well defined by available clinical trial evidence. However, for glucose-lowering drugs, further evidence is expected from several ongoing cardiovascular outcome trials. Taken together, the evidence highlights the value of early intervention and targeting multiple risk factors with both lifestyle and pharmacological strategies to give the best chance of reducing macrovascular complications in the long term.