Coronary artery disease and diabetes mellitus.
Coronary artery disease and diabetes mellitus.
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DOI：
10.1016/j.ccl.2014.04.001
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发表时间：
2014-08
影响因子：
2.4
通讯作者：
Edelman ER
中科院分区：
文献类型：
--
作者：
Aronson D;Edelman ER
冠心病(CAD)是糖尿病(DM)患者长期预后的主要决定因素。糖尿病与心脏病的死亡风险增加2到4倍有关。此外，在糖尿病患者中，心肌梗死后死亡率增加，合并冠心病的总体预后更差。血糖控制接近正常的时间中位数为3.5至5年，并不能减少心血管事件。因此，HbA1c<；7%的总体目标对大多数患者来说似乎是合理的。医源性低血糖是糖尿病血糖控制的限制因素，也是过度发病率和死亡率的独立原因。他汀类药物能有效减少重大冠状动脉事件、中风和冠状动脉血运重建的需要。为糖尿病和多支冠状动脉疾病患者选择最佳的心肌血运重建策略是至关重要的，这需要一个多学科的团队方法(“心脏团队”)。大规模的临床试验表明，对于许多有1支或2支冠状动脉病变的患者来说，任何干预措施都没有比最佳药物治疗(OMT)更好的预后益处。药物洗脱支架或裸金属支架的介入治疗适用于仍有OMT症状的患者。比较多支冠状动脉介入治疗和冠状动脉旁路移植(CABG)的随机试验一直表明，CABG在减少死亡率、心肌梗死和重复血管重建的需要方面具有优越性。
Coronary artery disease (CAD) is a major determinant of the long-term prognosis among patients with diabetes mellitus (DM). DM is associated with a 2 to 4-fold increased mortality risk from heart disease. Furthermore, in patients with DM there is an increased mortality after MI, and worse overall prognosis with CAD. Near-normal glycemic control for a median of 3.5 to 5 years does not reduce cardiovascular events. Thus, the general goal of HbA1c <7% appears reasonable for the majority of patients. Iatrogenic hypoglycemia is the limiting factor in the glycemic management of diabetes, and is an independent cause of excess morbidity and mortality. Statins are effective in reducing major coronary events, stroke, and the need for coronary revascularization. Selection of the optimal myocardial revascularization strategy for patients with DM and multivessel coronary artery disease is crucial and requires a multidisciplinary team approach (‘heart team’). Large scale clinical trials have shown that for many patients with 1- or 2-vessel coronary artery disease, there is little prognostic benefit from any intervention over optimal medical therapy (OMT). PCI with drug-eluting or bare metal stents is appropriate for patients who remain symptomatic with OMT. Randomized trials comparing multivessel PCI to coronary artery bypass grafting (CABG) have consistently demonstrated the superiority of CABG in reducing mortality, myocardial infarctions and need for repeat revascularizations.