Diabetes and cardiovascular disease:: The road to cardioprotection
Diabetes and cardiovascular disease:: The road to cardioprotection
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DOI：
10.1136/hrt.2005.063008
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发表时间：
2005-12-01
期刊：
影响因子：
5.7
通讯作者：
Providência, LA
中科院分区：
文献类型：
--
作者：
Monteiro, P;Gonçalves, L;Providência, LA
糖尿病是一种代谢性疾病，其发病率和患病率近几十年来显著增加，主要是因为2型糖尿病的增加，几乎占所有糖尿病病例的90%。世界卫生组织估计，到2025年，将有3亿糖尿病患者（占世界人口的5.4%）。老年患者受糖尿病的影响最大，因为这种疾病的患病率随着年龄的增长而增加，至少到75岁。全球人口的不断老龄化可以解释在不久的将来糖尿病患者预计增加的一半。1大血管疾病（冠状动脉疾病、中风和外周血管疾病）是2型糖尿病患者发病和死亡的主要原因。在英国前瞻性糖尿病研究（UKPDS）中，所有大血管并发症的10年风险是微血管并发症的4倍。冠状动脉疾病是糖尿病患者死亡的主要原因，女性患心血管疾病的风险高于男性。糖尿病患者急性冠脉综合征后的预后比非糖尿病患者差。这在ST段抬高和非ST段抬高急性心肌梗死（AMI）中均有记录。弗雷明汉心脏研究还显示，即使在对其他风险因素进行数据调整后，糖尿病患者在急性期和梗死后时期的死亡率、再梗死率和心力衰竭率都更高。因此，糖尿病患者可能从有效治疗缺血性心脏病的疗法中获得更大的益处。因此，挑战在于如何更有效地保护糖尿病患者的心脏。我们能实现这个目标吗？要回答这个问题，我们必须首先了解为什么糖尿病患者患心血管疾病的风险更高。
Diabetes is a metabolic disease whose incidence and prevalence has significantly increased in recent decades, mainly because of an increase in type 2 diabetes, which represents almost90% of all cases of diabetes. The World Health Organization estimates that, by 2025, there will be 300 million diabetic patients (5.4% of the world population). Older patients are most affected by diabetes, as the disease prevalence increases with age, at least up until 75 years. The progressive aging of the global population could explain about half of the predicted increase of diabetic patients in the near future. 1Macrovascular disease (coronary artery disease, stroke, and peripheral vascular disease) is responsible for the majority of morbidity and mortality associated with type 2 diabetes. In the UK prospective diabetes study (UKPDS), 2 the 10 year risk of all macrovascular complications was four times that of microvascular complications. Coronary artery disease is the leading cause of death among diabetic patients, and women have a higher cardiovascular risk than men. Diabetics have a worse prognosis after an acute coronary syndrome than non-diabetic patients. This was documented both for ST elevation and non-ST elevation acute myocardial infarction (AMI). The Framingham heart study has also shown a higher mortality rate, as well as reinfarction and heart failure rates, in diabetic patients, both during the acute phase and in the post-infarction period, even after data adjustment for other risk factors. 1 Diabetic patients may, therefore, derive a greater benefit from therapies shown to be effective in treating ischaemic heart disease. The challenge is, therefore, to protect the heart of diabetic patients more effectively. Can we achieve this goal? To answer this question we must first understand why patients with diabetes have a higher cardiovascular risk.