控制糖尿病患者心血管危险地干预治疗策略.ppt

控制糖尿病患者心血管危险的干预治疗策略 糖尿病与心血管危险 影响心血管危险的因素 综合控制的理论与实践 Type 2 diabetes and CHD7-Year Incidence of Fatal/Nonfatal MI (East West Study)  Type 2 diabetes and Stroke7-Year Incidence of Fatal/Nonfatal Stroke (East West Study) MetS和DM患者血脂异常特征 游离脂肪酸? TG? HDL-C? VLDL-C ? 小而密LDL颗粒? 氧化LDL-C ? 餐后高脂血症 UKPDS Stepwise Selection of Risk Factors* in Patients with Type 2 Diabetes Good glycemic control is not enough 糖尿病患者降压治疗临床试验 ? SHEP ? ALLHAT SYST-EUR ? HOPE CAPPP ? HOT NORDIL ? RENAAL STOP-2 ? PRIME INSIGHT ? LIFE UKPDS CHD Prevention Trials with Statins in Diabetic Subjects Subgroup Analyses Trials with Fibrates in Patients with Diabetes Countries With Highest Numbers of Estimated Cases of Diabetes for 2000 and 2030 Ranking Country People with diabetes (millions) Country People with diabetes (millions) 2000 2030 1 India 31.7 India 79.4 2 China 20.8 China 42.3 3 U.S. 17.7 U.S. 30.3 4 Indonesia 8.4 Indonesia 21.3 5 Japan 6.8 Pakistan 13.9 6 Pakistan 5.2 Brazil 11.3 7 Russian Federation 4.6 Bangladesh 11.1 8 Brazil 4.6 Japan 8.9 9 Italy 4.3 Pinecones 7.8 10 Bangladesh 3.2 Egypt1 6.7 Total: 177 million 366 MILLION BY 2030 Incidence During Follow-up (%) (n=69) Nondiabetics with prior MI Nondiabetics with no prior MI Diabetics with prior MI Diabetics with no prior MI 18.8 Haffner SM et al. N Engl J Med 1998;339:229-234. (n=1304) (n=169) (n=890) 3.0 0.5 7.8 3.2 3.5 45.0 20.2 Events per100 person-yr: P0.001 p0.001 Incidence During Follow-up (%) (n=69) Nondiabetics with prior MI Nondiabetics with no prior MI Diabetics with prior MI Diabetics with no prior MI 7.2 Haffner SM et al. N Engl J Med 1998;339:229-234. (n=1304) (n=169) (n=890) 1.2 0.3 3.4 1.6 1.9 19.5 10.3 Events per100 person-yr: P=0.01 p0.001 Prevalence of CHD by the Metabolic Syndrome and Diabetes in the NHANES Population Age 50+ Alexander C et al. Diabetes 2003;52:1210-1214