糖尿病患者的他汀应用.pptVIP

* 有关糖尿病患者是否有必要降胆固醇治疗，如何降，以及选用何种药物，大家可能还心存困惑，今天，我就从这三个方面与大家讨论。 * The risk of CAD and stroke is increased two to four times in patients with diabetes. Cardiovascular disease is a major cause of morbidity and mortality in diabetes. Morbidity and mortality rates are two to four times higher than in age- and sex-matched groups in the population without diabetes. The eye and the kidney are common sites for microvascular complications of diabetes. Diabetic retinopathy is the leading cause of adult blindness in North America. Cataracts and glaucoma are also significantly more frequent in patients with diabetes, especially those over age 65. Diabetes is the leading cause of end-stage renal failure. Foot problems, a frequent consequence of neuropathy and peripheral vascular disease, constitute a major complication. Diabetes is the leading cause of non-traumatic lower-extremity amputations in North America. * 欧洲心脏调查结果，在分析生存率与高血糖状态的关系时发现，冠心病患者高血糖状态持续时间越长，生存率越低 * * 有关糖尿病患者是否有必要降胆固醇治疗，如何降，以及选用何种药物，大家可能还心存困惑，今天，我就从这三个方面与大家讨论。 * 为什么相同LDL-C水平，糖尿病患者具有更高的心血管病死亡风险呢？ 经过长期的研究人们发现，糖尿病患者由于存在糖耐量异常和胰岛素抵抗，糖尿病患者具有有别于非糖尿病患者的脂代谢特点。糖尿病患者的血脂异常特点是甘油三酯水平显著升高，LDL-C水平轻微升高和HDL-C水平降低，其中LDL-C升高以小而密的LDL-C升高为主。以上这些异常都有致动脉粥样硬化的作用，并共同构成一组相关的危险因素，其中，小而密LDL-C升高最危险。 * 小而密LDL的致动脉粥样硬化作用更强。 首先，小而密LDL与低密度脂蛋白受体结合力下降，经受体通路清除减慢。致使小而密LDL在血中滞留时间延长。正常LDL通过受体通路进行清除的时间大约为一天，而小而密LDL可能长达数天。 其次，这种小而密LDL容易被氧化形成过氧化脂质，经受体通路清除减缓，只能通过非受体通路进行清除，被单核-巨噬细胞的清道夫受体识别、吞噬，进入血管内皮，形成泡沫细胞，促进动脉粥样硬化的发生。 More of our EASD 2010 coverage ? Lipid/Metabolic All diabetics over 40 should be on statins, EASD told October 1, 2010 | Stockholm, Sweden - All people over the age of 40 with diabetes—type 1 or type 2—should be taking statins to reduce their risk of stroke or coronary events, one expert stressed to diabetes doctors at the European Association for the Study of Diabetes (EASD) 2010 Meeting last week. Dr John Betteridge (University College London, UK) outlined the evidence base for statins in diabetes and stressed their safety,