糖尿病血脂异常的防治策略绪论.ppt

中国2007-2008糖尿病流行病学调查 心血管病综合危险分类 * * Sim:40mg 80mg HDL颗粒的功能异质性 ApoAI作为HDL的主要组成蛋白, 在RCT中起了很大作用. ApoAI能诱发ABCA1和卵磷脂胆固醇酰基转移酶的活性, 也是HDL分解代谢(cubilin受体和B链ATP合酶)和胆固醇脂选择性摄取中涉及的膜联受体(SR-B1)的配体. ApoAII存在于部分HDL中.在动物模型中可能有致动脉粥样硬化性.只含有ApoAI(Lp AI)的HDL颗粒主要是HDL2. 与Lp AI+II的HDL相比, HDL2是外周细胞ATP结合和转运体A1(ABCA1)的游离胆固醇更有效的受体, 也是肝脏细胞SR-B1素胆固醇脂的更有效受体 * 尽管已经把糖尿病作为冠心病的等危因素，但是仍然需要一些前瞻性试验数据来强调在糖尿病患者中控制CVD风险的重要性。 目前，关于他汀药物在预防糖尿病患者心血管病的作用方面，只有一些长期大规模临床试验的亚组分析数据。这些试验数据显示，在降低心血管病风险方面，他汀类药物对糖尿病患者的疗效至少和对CHD患者的疗效一样。 除了心脏保护试验（HPS）之外，在这些试验中只有一小部分糖尿病患者的试验数据用于评估分析。因此目前需要大规模的试验，来充分评估他汀类药物对糖尿病患者可能存在的临床获益，尤其是在一级预防中的临床获益。 Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002;360:7-22. Collins R, Armitage J, Parish S, Sleigh P, Peto R; Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial. Lancet. 2003;361:2005-16. Athyros VG, Papageorgiou AA, Mercouris BR, et al. Treatment with atorvastatin to the National Cholesterol Educational Program goal versus ‘usual’ care in secondary coronary heart disease prevention. The GREek Atorvastatin and Coronary heart-disease Evaluation (GREACE) study. Curr Med Res Opin. 2003;18:220-228. Goldberg RB, Mellies MJ, Sacks FM, et al, for the CARE Investigators. Cardiovascular events and their reduction with pravastatin in diabetic and glucose-intolerant myocardial infarction survivors with average cholesterol levels: subgroup analyses in the Cholesterol and Recurrent Events (CARE) trial. Circulation. 1998;98:2513-2519. Haffner SM, Alexander CM, Cook TJ, et al. Reduced coronary events in simvastatin-treated patients with coronary heart disease and diabetes or impaired fasting glucose levels: subgroup analyses in the Scandinavian Simvastatin Survival Study. Arch Intern Med. 1999;159:2661-2667. Py?r?l?