糖尿病合并高血脂.PPT

血脂異常合併 糖尿病或代謝症候群 臺中榮民總醫院 內分泌暨新陳代謝科 主治醫師 李奕德 糖尿病 and 高血脂 高血脂是心臟血管疾病的主因 糖尿病的角色? Type 2 Diabetes Prevalence Is Projected to Reach 300 Million by 2025 About 155 million adults worldwide diagnosed with diabetes in 2000 83 million women and 72 million men Type 2 Diabetes Prevalence will reach 300 million in 2025 Prevalence of Hyperglycemiaby Age Group in Taiwan Increased Risk of CV Events Over 7 years in Type 2 Diabetics Prevalence of hyperglycemia with Co-morbid diseases 糖尿病的治療準則 A1c Blood pressure Cholesterol (lipid) Diet control Exercise Factors reduction 心血管死亡風險(MRFIT study): 低膽固醇糖尿病患者比高膽固醇但無糖尿病的人高 糖尿病的apoB濃度更高 在 UKPDS 研究中LDL-C 是預測糖尿病患者 CHD 罹病風險時最有力的指標 The Pyramid of Recent TrialsRelative Size of the Various Segments of the Population CARDS Study Recruitment and Follow Up TC and LDL-C Levels Effect of Atorvastatin on the Primary End Point: Major CV Events Including Stroke CARDS Summary statin provided benefits in type 2 diabetes with no history of CVD and with normal to mildly-elevated cholesterol levels 37% reduction in major CVD events (P=0.001) 48% reduction in stroke (P=0.016) 27% reduction in all-cause mortality (P=0.059) Adult Treatment Panel III (ATP III) Guidelines National Cholesterol Education Program 治療的主要目標 LDL cholesterol LDL 的升高是心臟血管疾病的主因 降低LDL 可減少心臟血管疾病的風險 ATP III 治療的主要目標著重在 LDL. 高危險群 CHD History of CHD CHD risk equivalents Other clinical forms of atherosclerotic disease peripheral arterial disease abdominal aortic aneurysm symptomatic carotid artery disease Diabetes (糖尿病) Multiple risk factors with a 10-year risk for CHD 20% Three Categories of Risk that Modify LDL-Cholesterol Goals Risk Category CHD and CHD risk equivalents Multiple (2+) risk factors 0 - 1 one risk factor LDL Goal (mg/dL) 100 130 160 Prevalence of the Metabolic Syndrome Difference in Asian 國內成人肥胖定義 Metabolic Syndrome, carotid atherosclerosis and LDL size LDL size in metabolic syndrome Gemfibrozil for insulin resistance 代謝症候群 (metabolic syndrome) 第二個治療目標 LDL控制之