Diabetes and cardiovascular disease.
Diabetes and cardiovascular disease.
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DOI：
10.1007/s11883-000-0046-8
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发表时间：
2000-11-01
影响因子：
5.8
通讯作者：
Magee, M F
中科院分区：
文献类型：
--
作者：
Howard, B V;Magee, M F
心血管疾病（CVD）是2型糖尿病最常见和最昂贵的并发症。在这篇综述中，我们研究了糖尿病对心血管疾病的影响。一些流行病学研究揭示了糖尿病/心血管疾病的关系，这些研究集中在印第安人身上，他们过去很少或根本没有糖尿病或心血管疾病，但今天这两种疾病都在流行。几乎一半的美洲原住民在基线时患有糖尿病。当CVD事件按糖尿病状态分层时，男性糖尿病患者的相对CVD风险是非糖尿病男性的两倍，女性糖尿病患者的风险是非糖尿病女性的三倍。在所有心血管疾病事件中，糖尿病在男性中占56%，在女性中占78%；大多数心血管疾病死亡发生在糖尿病患者中。最近的注意力集中在确定糖尿病人群中心血管疾病危险因素的相对强度上。在许多人群中，糖尿病患者的低密度脂蛋白（LDL）胆固醇较低。然而，在美洲印第安人中，低密度脂蛋白胆固醇每增加10mg /dL与心血管疾病风险增加12%相关，高密度脂蛋白胆固醇每减少10mg /dL与心血管疾病风险增加8%相关。蛋白尿是糖尿病人群CVD的重要预测指标。有大量蛋白尿的人患心血管疾病的风险是没有蛋白尿的糖尿病人的四到五倍。最近在其他人群中，糖尿病的其他心血管疾病危险因素是纤维蛋白原、c反应蛋白和白细胞增多。糖尿病患者的血管生成反应可能较低，感染可能在糖尿病患者中起作用。低密度脂蛋白胆固醇和蛋白尿应成为预防策略的目标，并应进一步探索有前途的新领域，如细胞因子、生长因子和感染的作用。
Cardiovascular disease (CVD) is the most frequent and costly complication of type 2 diabetes. In this review, we examine the impact of diabetes on CVD. Shedding some light on the diabetes/CVD relationship are epidemiologic studies, which focused on Native Americans, who collectively experienced little or no diabetes or CVD in the past, but experience both conditions in epidemic proportions today. Almost half of the Native Americans studied had diabetes at baseline. When CVD events were stratified by diabetic status, the relative CVD risk among diabetic men was twice that of nondiabetic men, and the risk among diabetic women was threefold that of nondiabetic women. Among all CVD events, diabetes accounted for 56% in men and 78% in women; most CVD deaths occurred in those with diabetes. Recent attention has focused on defining the relative strength of CVD risk factors in diabetic populations. In many populations, low-density lipoprotein (LDL) cholesterol is lower in diabetic individuals. However, in American Indians, every 10-mg/dL increase in LDL cholesterol has been associated with a 12% increase in CVD risk and every 10-mg/dL decrease in high-density lipoprotein (HDL) cholesterol was associated with an 8% increase in CVD risk. Albuminuria is an important predictor of CVD in diabetic populations. Those with macroalbuminuria had a CVD risk that was four to five times that of diabetic individuals without albuminuria. Other CVD risk factors in diabetes that have come under recent scrutiny in other populations are increased levels of fibrinogin, and C-reactive protein, and leukocytosis. Angiogenic response may be lower in diabetic individuals, and the possible role of infection is being examined in diabetic patients. LDL cholesterol and albuminuria should be the targets of preventive strategies, and promising new areas such as cytokines, growth factor, and the role of infection should be further explored.