Dyslipidemia in type II Diabetes: Implications for Therapeutic Intervention
Dyslipidemia in type II Diabetes: Implications for Therapeutic Intervention
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II 型糖尿病中的血脂异常：治疗干预的意义
作者：
M. Stern;S. Haffner
心血管疾病，特别是缺血性心脏病，是非胰岛素依赖型（II型）糖尿病患者发病、功能残疾和死亡的主要原因。糖尿病大血管并发症的主要危险因素是血脂异常、高血压和吸烟。虽然高血糖程度是微血管并发症的危险因素，但它不是大血管并发症的重要危险因素。然而，理论上有理由相信控制血糖可以降低心血管风险。例如，控制血糖既可以提高清除率，又可以抑制肝脏中极低密度脂蛋白的过量产生。此外，有直接的经验证据表明，改善血糖控制可以改善II型糖尿病患者的脂质谱。尽管如此，唯一一项以糖尿病患者心血管死亡率为终点的临床试验（即大学组糖尿病项目）未能证明血糖控制的益处。在这项研究中，相对于安慰剂组，胰岛素变量组实现了持续的血糖控制，其心血管死亡率与安慰剂组基本相同。所有传统的降脂药物已被证明对糖尿病患者的脂质谱产生有利的变化。然而，最佳方案仍有待确定。糖尿病患者和非糖尿病患者之间的代谢差异意味着两类患者的最佳降脂方案可能不同。例如，烟酸是一种强效的脂质改变药物，可能会加重葡萄糖耐受不良。2型糖尿病患者的特征性脂质异常是高甘油三酯血症和低高密度脂蛋白胆固醇，而不是高胆固醇血症。尽管高甘油三酯血症在普通人群中作为心血管危险因素的作用一直受到质疑，但有证据表明，这种脂质异常可能在糖尿病患者中发挥更大的作用。由于上述所有原因，迫切需要进行大规模的临床试验，评估心血管终点，测试改善糖尿病受试者脂质谱的各种策略，特别是考虑到当前所有的降脂试验都系统地排除了糖尿病患者。
Cardiovascular disease, and in particular ischemic heart disease, is the principal cause of morbidity, functional disability, and mortality in patients with non-insulin-dependent (type II) diabetes. The main risk factors for the macrovascular complications of diabetes are dyslipidemia, hypertension, and cigarette smoking. Although degree of hyperglycemia is a risk factor for microvascular complications, it is not a prominent risk factor for macrovascular complications. Nevertheless, there are theoretical reasons for believing that glycemic control could lower cardiovascular risk. For example, glycemic control may both improve clearance and suppress hepatic overproduction of very-low-density lipoprotein. Moreover, there is direct empirical evidence that improved glycemic control can favorably alter lipid profiles in type II diabetic patients. Despite this, the only clinical trial that has assessed cardiovascular mortality as an end point in diabetic subjects (i.e., the University Group Diabetes Program) failed to demonstrate a benefit of glycemic control. In this study, the insulin-variable group, which achieved sustained glycemic control relative to the placebo group, had essentially the same cardiovascular mortality as the latter group. All of the conventional lipid-lowering agents have been shown to produce favorable changes in lipid profiles in diabetic subjects. However, the optimum regimen remains to be defined. Metabolic differences between diabetic and nondiabetic subjects mean that the optimum lipid-lowering regimens for the two categories of patients may differ. For example, nicotinic acid, which is a powerful lipid-altering drug, may worsen glucose intolerance. The characteristic lipid abnormalities in type II diabetic subjects are hypertriglyceridemia and low high-density lipoprotein cholesterol, not hypercholesterolemia. Although the role of hypertriglyceridemia as a cardiovascular risk factor in the general population has been questioned, there is evidence that this lipid abnormality may play a stronger role in diabetic subjects. For all of the above reasons, there is an urgent need for large-scale clinical trials assessing cardiovascular end points and testing various strategies of improving lipid profiles in diabetic subjects, particularly given the fact that all of the current generation of lipid-lowering trials have systematically excluded diabetic patients.
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普罗布考对人体胆固醇和脂蛋白代谢的影响。
影响因子：
6.5
作者：
Kesäniemi,YA;Grundy,SM
通讯作者：
Grundy,SM
在非胰岛素依赖型糖尿病中，当用胰岛素控制高血糖时，降低的血浆高密度脂蛋白胆固醇浓度不需要增加。
DOI：
10.1210/jcem-62-3-605
发表时间：
1986
期刊：
The Journal of clinical endocrinology and metabolism
影响因子：
--
作者：
Hollenbeck,CB;Chen,YD;Greenfield,MS;Lardinois,CK;Reaven,GM
通讯作者：
Reaven,GM
吉非贝齐治疗与冠心病相关的原发性高甘油三酯血症。
DOI：
--
发表时间：
1985
期刊：
JAMA : the journal of the American Medical Association
影响因子：
--
作者：
Vega,GL;Grundy,SM
通讯作者：
Grundy,SM
成人非胰岛素依赖型糖尿病患者高密度脂蛋白的社区研究。
影响因子：
5
作者：
Barrett-Connor,E;Witztum,JL;Holdbrook,M
通讯作者：
Holdbrook,M
DOI：
10.1001/jama.1988.03410190112033
发表时间：
1988-11
期刊：
JAMA
影响因子：
--
作者：
R. Klein;B. Klein;S. Moss;M. Davis;D. DeMets
通讯作者：
R. Klein;B. Klein;S. Moss;M. Davis;D. DeMets