糖代谢异常与心血管疾病临床诊断和治疗指南ppt课件.ppt

大庆研究20年随访：生活方式干预显著降低糖尿病发病风险 Lancet. 2008 May 24;371(9626):1783-9 进展为2型糖尿病的百分比(％) 随访时间(年) 对照 干预 6年干预风险的危险比：0.49(95%CI 0.33-0.73) 20年随访的危险比：0.57(95%CI 0.41-0.81) 0 2 4 6 8 10 12 14 16 18 20 100 90 80 70 60 50 40 30 20 10 92.8% 大庆研究20年随访结果显示，6年强化干预生活方式干预，降低糖尿病发病风险 糖尿病患者的降压选择：RAS抑制剂 ADA 2011推荐：糖尿病患者降压用药首选ACEI或ARB。 RAS抑制剂作为糖尿病患者的降压用药有其独特优势。 保护靶器官 减轻蛋白尿# P＜0.001 降低新发糖尿病风险* P＜0.05 RAS抑制剂 50.5% 74% #Ann Intern Med. 2001;134:370-379 *Diabetes Metab 2004,30,487-496 2013 年ESC/EASD联合发布第二版欧洲糖尿病、糖尿病前期和心血管疾病指南 这是ESC与EASD合作开发的关于DM、糖尿病前期和CVD的管理第二代指南。这些指南旨在帮助临床医师和其他保健工作者作循证管理决策。人们日益认识到DM与CVD之间存在密切的关系，促使这些组织协作开发与其共同感兴趣相关的指南，第一版指南于2007年发表。 Eur Heart J. 2013 Oct;34(39):3035-87 JUPITER研究：糖尿病患者中他汀的获益明确 Lancet. 2012 August 11; 380(9841): 565–571. n=17603，无CVD或糖尿病史的受试者随机分20mg瑞舒伐他汀治疗组或安慰剂治疗5年。研究主要终点为心梗、卒中、不稳定心绞痛入院、动脉血运重建及心血管死亡 比例尺，统一。 * 各个研究样本量，OGTT。 * * * * * * * Intensive blood pressure (BP) control reduces the risk of diabetes-related death, stroke, and microvascular end points in patients with diabetes and hypertension. The United Kingdom Prospective Diabetes Study (UKPDS-38) compared the effect of tight BP control with less tight BP control in 1,148 hypertensive patients with type 2 diabetes over a median follow-up of 8.4 years. The tight BP control group was assigned a BP target of 150/85 mm Hg and were treated with antihypertensives (captopril or atenolol) and diet. The less tight BP control group had a BP target of 180/105 mm Hg and was treated with diet alone. Additional antihypertensive agents could be added to either group if the control criteria were not met. Tight BP control reduced the risk of developing any end point related to diabetes by 24% compared with less tight BP control (P =.005). Compared with less tight BP control, tight BP control specifically reduced the risk of diabetes-related mortality (two thirds of diabetes-related mortality was due to cardiovascular disease) by 3