糖尿病与心衰发生机制及诊疗现状PPT.ppt

糖尿病与心力衰竭—发生机制和诊疗进展 南方医院心血管内科 许 顶 立 美国心血管疾病发病率和死亡原因百分比 发病率 心血管死因构成比 AHA 2001 0.5% 0.5% 50M 12.4M 4.5M 1M 4.7M 1 in 5 males and females has some form of cardiovascular disease 心力衰竭的死亡率 Framingham的研究（1948年～1988年）： 有症状的心力衰竭患者，男性患者平均存活时间为3.2年，女性为5.4年。 心力衰竭的年发病率 Diabetes is the leading cause of blindness in patients aged 20-74 years. Diabetes is also the leading cause of end-stage renal disease. Approximately 60-70% of patients with diabetes develop some degree of neuropathy, including erectile dysfunction. 60-70% of all diabetes-related deaths are attributable to the macrovascular manifestations of the disease. Diabetic vascular disease is responsible for a 2- to 4-fold increase in the incidence of coronary heart disease (CHD) and stroke and a 2- to 8-fold increase in the risk for heart failure. Diabetes have a 15- to 40-fold increased risk for lower extremity amputations. Pharmacotherapy 2002, 22(4):436-444. During 13,811 person-years of follow-up, 173 subjects developed incident heart failure, as confirmed by chart review. Five factors were independent predictors of heart failure: male sex (RR = 1.7; CI, 1.3 to 2.4), older age (RR = 1.9; CI, 1.3 to 2.7 for age 75 to 84 years, RR = 3.0; CI, 1.7 to 5.5 for age 85 years and older, compared with or = 74 years), diabetes (RR = 2.9; CI, 2.0 to 4.3), pulse pressure or = 70 mm Hg (RR = 2.3; CI, 1.3 to 4.3, compared with 50 mm Hg), and body mass index or = 28 kg/m2 (RR = 1.6; CI, 1.0 to 2.4, compared with 24 kg/ m2). Myocardial infarction occurred during follow-up in 8% of the cohort and was also an important predictor of heart failure (RR = 21; CI, 15 to 31). The development of heart failure in the elderly Am J Med 1999 Jun;106(6):605-12 Diabetic cardiomyopathy?Spector KS Prior to 1972, the increased cardiovascular morbidity and mortality that diabetics endure had been attributed to vascular disease. In 1972, Rubler et al. proposed the existence of a diabetic cardiomyopathy based on their expereince with four