Coronary heart disease in patients with diabetes - Part I: Recent advances in prevention and noninvasive management
Coronary heart disease in patients with diabetes - Part I: Recent advances in prevention and noninvasive management
复制标题
DOI：
10.1016/j.jacc.2006.09.046
复制
发表时间：
2007-02-13
影响因子：
24
通讯作者：
Bourassa, Martial G.
中科院分区：
文献类型：
--
作者：
Berry, Colin;Tardif, Jean-Claude;Bourassa, Martial G.
糖尿病（DM）是一种世界性流行病。它的流行在发展中国家和发达国家都在迅速增加。冠心病（CHD）非常普遍，是糖尿病患者发病和死亡的主要原因。本综述的目的是评估糖尿病患者冠心病的流行病学、预防和管理方面的最新进展的临床影响。对过去5年（2000年至2005年）在MEDLINE中引用的这一领域的出版物进行了系统回顾。冠心病和糖尿病前期患者应通过改变生活方式来预防糖尿病。糖尿病的药物预防也很有希望，但需要进一步研究。对于冠心病和糖尿病患者，强烈建议常规使用阿司匹林和血管紧张素转换酶抑制剂（ACE-I），除非有禁忌症或不能耐受，并严格控制血糖、血压和血脂。这些患者的二级预防目标相对明确，但实现这些目标的策略各不相同，必须因地制宜。可能需要高强度胰岛素治疗来控制血糖，可能需要高剂量他汀类药物治疗来控制血脂。对于血压控制，ACE-is和血管紧张素受体阻滞剂被认为是一线治疗。不依从性，特别是生活方式措施，以及循证治疗处方不足仍然是重要的未解决问题。
Diabetes mellitus (DM) is a worldwide epidemic. Its prevalence is rapidly increasing in both developing and developed countries. Coronary heart disease (CHD) is highly prevalent and is the major cause of morbidity and mortality in diabetic patients. The purpose of this review is to assess the clinical impact of recent advances in the epidemiology, prevention, and management of CHD in diabetic patients. A systematic review of publications in this area, referenced in MEDLINE in the past 5 years (2000 to 2005), was undertaken. Patients with CHD and prediabetic states should undergo lifestyle modifications aimed at preventing DM. Pharmacological prevention of DM is also promising but requires further study. In patients with CHD and DM, routine use of aspirin and an angiotensin-converting enzyme inhibitor (ACE-I)-unless contraindicated or not tolerated-and strict glycemic, blood pressure, and lipid control are strongly recommended. The targets for secondary prevention in these patients are relatively well defined, but the strategies to achieve them vary and must be individualized. Intense insulin therapy might be needed for glycemic control, and high-dose statin therapy might be needed for lipid control. For blood pressure control, ACE-is and angiotensin receptor blockers are considered as first-line therapy. Noncompliance, particularly with lifestyle measures, and underprescription of evidence-based therapies remain important unsolved problems.