The effect of interventions to prevent cardiovascular disease in patients with type 2 diabetes mellitus
The effect of interventions to prevent cardiovascular disease in patients with type 2 diabetes mellitus
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DOI：
10.1016/s0002-9343(01)00978-0
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发表时间：
2001-12-01
影响因子：
5.9
通讯作者：
Singer, DE
中科院分区：
文献类型：
--
作者：
Huang, ES;Meigs, JB;Singer, DE
心血管并发症占2型糖尿病患者死亡率的50%以上。我们量化降低胆固醇，血压和葡萄糖水平在这些patients.METHODS：我们进行了随机对照试验的荟萃分析，在2型糖尿病或糖尿病亚组，比较心血管的影响，在标准治疗或安慰剂的危险因素水平的强化药物控制。我们通过检索MEDLINE（1966年至2000年）和综述文章确定试验。使用指定的方案获得治疗详情、患者特征和结局事件。使用固定效应模型汇总数据。结果：7项血清胆固醇降低试验，6项血压降低试验和5项血糖降低试验符合合格标准。对于总体心脏事件（冠心病死亡和非致死性心肌梗死）、胆固醇降低[率比（RR）= 0.75; 95%置信区间（Cl）：0.61 - 0.93）和血压降低（RR = 0.73; 95% CI：0.57至0.94）产生了巨大的，显著的影响，而强化降糖降低了事件发生率，但未达到统计学显著性（RR = 0.87; 95% CI：0.74 - 1.01）。我们观察到所有个体心血管结局的这种模式。对于降胆固醇和降血压治疗，69至300人-年的治疗需要防止一个心血管事件。结论：从这些临床试验的证据表明，2型糖尿病患者的血脂和血压降低与大量的心血管疾病的好处。强化降糖对于预防微血管疾病至关重要，但胆固醇和血压水平的改善对于减少这些患者的心血管疾病至关重要。
PURPOSE: Cardiovascular complications account for over 50% of mortality among patients with type 2 diabetes mellitus. We quantify the cardiovascular benefit of lowering cholesterol, blood pressure, and glucose levels in these patients.METHODS: We conducted a meta-analysis of randomized controlled trials in type 2 diabetes or diabetes subgroups, comparing the cardiovascular effects of intensive medication control of risk factor levels in standard therapy or placebo. We identified trials by searching MEDLINE (1966 to 2000) and review articles. Treatment details, patient characteristics, and outcome events were obtained using a specified protocol. Data were pooled using fixed-effects models.RESULTS: Seven serum cholesterol-lowering trials, six blood pressure-lowering trials, and five blood glucose-lowering trials met eligibility criteria. For aggregate cardiac events (coronary heart disease death and nonfatal myocardial infarction), cholesterol lowering [rate ratio (RR) = 0.75; 95% confidence interval (Cl): 0.61 to 0.93) and blood pressure lowering (RR = 0.73; 95% Cl: 0.57 to 0.94) produced large, significant effects, whereas intensive glucose lowering reduced events without reaching statistical significance (RR = 0.87; 95% CI: 0.74 to 1.01). We observed this pattern for all individual cardiovascular outcomes. For cholesterol-lowering and blood pressure-lowering therapy, 69 to 300 person-years of treatment were needed to prevent one cardiovascular event.CONCLUSIONS: The evidence from these clinical trials demonstrates that lipid and blood pressure lowering in patients with type 2 diabetes is associated with substantial cardiovascular benefits. Intensive glucose lowering is essential for the prevention of microvascular disease, but improvements in cholesterol and blood pressure levels are central to reducing cardiovascular disease in these patients.