PREVENTION OF CARDIOVASCULAR DISEASE IN DIABETES MELLITU

大多数糖尿病患者死于心血管疾病（CVD），糖尿病患者的心血管疾病发病率是非糖尿病人群的2至4倍。心血管疾病风险的增加，以及美国人口中肥胖和老年人数的增加，意味着糖尿病相关的心血管疾病将在未来成为一个更大的公共卫生问题。糖尿病是一种复杂的代谢紊乱，胰岛素抵抗水平一般可评估，循环胰岛素水平可变，通常伴有碳水化合物、脂质和蛋白质代谢异常以及血压升高。虽然血糖控制对2型患者很重要，但关键是不要忽视相关CVD危险因素异常的治疗。2型糖尿病患者强化控制已确定的心血管疾病危险因素（血压和血脂）和强化控制血糖对预防心血管疾病事件的影响尚不清楚。该研究是一项多中心随机临床试验，对大约1万名成年2型糖尿病患者进行了4至7年的随访。本研究计划的主要目的是评估是否可以通过以下方式降低主要心血管疾病事件的发生率：(1)与常规控制相比，强化血糖控制；(2)与常规控制相比，强化血压控制；(3)与常规对照相比，强化控制血脂。其他目标包括上述干预措施的相对成本效益及其对与健康有关的生活质量的影响。

Most diabetic patients die of cardiovascular disease (CVD), with CVD rates in diabetic persons two to four times those of the non-diabetic population. This increased CVD risk, along with the increasing prevalence of obesity and increasing numbers of elderly in the U.S. population, means that diabetes-associated CVD will become an even greater public health problem in the future. Diabetes mellitus is a complex metabolic disorder with generally evaluated levels of insulin resistance and variable levels of circulating insulin, which is often accompanied by abnormalities in carbohydrate, lipid, and protein metabolism and elevated blood pressure. While glucose control appears important for Type 2 patients, it is critical not to overlook treatment of associated CVD risk factor abnormalities. The effects on prevention of cardiovascular disease events of intensive control of established CVD risk factors (blood pressure and blood lipids), and intensive control of blood glucose, in Type 2 diabetes are unknown. The study is a multi-center randomized clinical trial of about 10,000 adult patients with Type 2 diabetes mellitus followed for four to seven years. The primary objective of this research program is to assess whether the rate of major cardiovascular disease events can be reduced by: (1) intensive control of blood sugar compared with conventional control; (2) intensive control of blood pressure compared with conventional control; and (3) intensive control of blood lipids compared with conventional control. Other objectives include the comparative cost effectiveness of the above interventions and their impact on health-related quality of life.