糖尿病心血管并发症水标准化药物治疗策略.ppt

为什么综合因素治疗疗效更好呢？因为糖尿病不仅仅是一种高血糖疾病 * 因此降低糖尿病患者死亡率首先要减少整体心血管风险，具体的治疗方法就是同时控制多种危险因素。 2型糖尿病与冠心病风险显著增加相关，EAST-WEST研究对1373例无糖尿病患者及1059例糖尿病患者的7年心肌梗死发病率进行了比较，结果显示，无心肌梗死病史的糖尿病患者与有心肌梗死病史的非糖尿病患者具有同等高的心肌梗死风险。可以说糖尿病即是冠心病的“等危症” * 高血压、血脂异常和糖代谢异常相互恶化，并促使机体发生动脉粥样硬化，从而导致心血管事件，最终导致死亡。由此可见，单纯降糖无法全面阻断糖尿病血管并发症进程 A new paradigm in the treatment of the cardiovascular disease continuum: focus on prevention Chrysant SG Oklahoma Cardiovascular and Hypertension Center, Oklahoma City, Oklahoma, USA Abstract The cardiovascular disease continuum (CVDC) is a sequence of cardiovascular events, which begins from a cluster of cardiovascular risk factors consisting of diabetes mellitus, dyslipidemia, hypertension, smoking and visceral obesity. If these factors are not intervened with early, they will, inexorably, progress to atherosclerosis, coronary artery disease, myocardial infarction, left ventricular hypertrophy, left ventricular dilatation leading to left ventricular diastolic or systolic dysfunction and eventually end stage heart failure and death. For this concise review, a Medline search of the English language literature between the years 2000 and 2009 was conducted and 33 pertinent publications were selected. Based on the evidence contained in these publications, it is possible that early intervention and treatment of the various cardiovascular risk factors, which initiate and perpetuate the CVDC, could prevent it or arrest its further progress. Therefore, this concise review will emphasize the early detection and treatment of the various cardiovascular risk factors, which initiate and perpetuate the CVDC. Hippokratia 2011; 15 (1): 7-11 * 由此看来糖尿病、高血压和高血脂之间的关系非同一般。那么我们应该如何治疗才能取得更高的收益呢？仅仅控制单一因素就够了吗？ 英国糖尿病前瞻性研究（UKPDS）始于1977年，研究目的在于回答一个基本问题：在2型糖尿病患者中，强化血糖控制能否降低糖尿病并发症的危险。 共有5102例新诊断为2型糖尿病的患者入选。在3个月的饮食治疗后，4209例患者被随机分配入组。除少数肥胖患者被随机分配使用二甲双胍治疗外共342例患者，其他患者则随机接受常规治疗（1138例）或强化治疗（2729例）。常规治疗组主要是生活方式干预，血糖控制不佳者被随机分配入磺脲类、胰岛素或二甲双胍肥胖者治疗组；强化治疗组于研究开始时，随机接受胰岛素（1156例）或磺脲类（1573）例治疗，目的是将空腹血糖控制在6mmol/L（108mg/dL）以下