Management of Type 2 Diabetes Mellitus and Cardiovascular Risk
Management of Type 2 Diabetes Mellitus and Cardiovascular Risk
复制标题
2 型糖尿病和心血管风险的管理
作者：
H. Yki
虽然2型（非胰岛素依赖型）糖尿病的诊断是在血糖水平超过增加微血管并发症风险的值时做出的，但大血管疾病是2型糖尿病的主要并发症。流行病学和前瞻性数据均表明，治疗高血压在降低微血管疾病风险方面显著有效，但在降低心肌梗死、卒中和外周血管疾病风险方面效力较低。其他心血管危险因素的治疗，虽然根据定义不如高脂血症普遍，但在预防大血管疾病方面似乎比治疗高脂血症更有效。近年来，来自干预试验的数据表明，通过有效治疗高血压和高胆固醇血症，以及使用小剂量阿司匹林（乙酰水杨酸），可以获得比单独治疗高胆固醇血症更大的预防大血管疾病的益处。另一方面，英国前瞻性糖尿病研究（UKPDS）检查了强化血糖和血压（BP）控制对微血管和大血管并发症的影响，是唯一一项仅纳入2型糖尿病患者的干预试验。然而，UKPDS数据、2型糖尿病患者数量的流行性增加及其高心血管风险已经启动了几项新的试验，特别是针对这些患者中最常见的血脂异常（高血清甘油三酯和低高密度脂蛋白胆固醇水平）治疗的可能获益。因此，2型糖尿病是一种与高血管风险相关的疾病，其中大多数患者需要并可能受益于几种心血管风险因素的药物治疗，前提是治疗目标尚未通过生活方式改变实现。
Although the diagnosis of type 2 (noninsulin-dependent) diabetes mellitus is made when blood glucose levels exceed values which increase the risk of micro-vascular complications, macrovascular disease is the major complication of type 2 diabetes mellitus. Both epidemiological and prospective data have demonstrated that treatment of hyperglycaemia is markedly effective in reducing the risk of microvascular disease but is less potent in reducing that of myocardial infarction, stroke and peripheral vascular disease. Treatment of other cardiovascular risk factors, although by definition less prevalent than hyperglycaemia, appears to be more effective in preventing macrovascular disease than treatment of hyperglycaemia. In recent years, data from intervention trials have suggested that greater benefits with respect to the prevention of macrovascular disease can be achieved by effective treatment of hypertension and hypercholesterolaemia, and by the use of small doses of aspirin (acetylsalicylic acid) than by treating hyperglycaemia alone. On the other hand, the UK Prospective Diabetes Study (UKPDS), which examined the impact of intensive glucose and blood pressure (BP) control on micro- and macrovascular complications, is the only intervention trial to include only patients with type 2 diabetes mellitus. The UKPDS data, the epidemic increase in the number of patients with type 2 diabetes mellitus and their high cardiovascular risk have, however, initiated several new trials addressing, in particular, the possible benefits of treatment of the most common form of dyslipidaemia (high serum triglyceride and low high density lipoprotein cholesterol levels) in these patients. Type 2 diabetes mellitus is thus a disease associated with a high vascular risk, where the majority of patients need, and are likely to benefit from, pharmacological treatment of several cardiovascular risk factors provided treatment targets have not been achieved by life-style modification.
影响因子：
158.5
作者：
Estacio, RO;Jeffers, BW;Schrier, RW
通讯作者：
Schrier, RW
DOI：
10.1056/nejm199607253350401
发表时间：
1996-07
期刊：
The New England journal of medicine
影响因子：
--
作者：
M. Bourassa;R. Frye;S. King;K. Detre;E. Alderman;K. Andrews;G. Sopko
通讯作者：
M. Bourassa;R. Frye;S. King;K. Detre;E. Alderman;K. Andrews;G. Sopko
影响因子：
16.2
作者：
Haffner, SM;D'Agostino, R;Saad, MF
通讯作者：
Saad, MF