有效治疗糖尿病改善心血管病预后方式.pptVIP

* 1/Malmberg/ 1/abstract 1/Malmberg/9/ figure 2 1/Malmberg/8/1 * * * * * * Potential antidiabetic mechanisms of ACE inhibition * HOPE, EUROPA, PEACE: Reduction in new-onset diabetes (placebo-controlled trials) * DREAM: Ramipril effect on primary outcome * * * * * * * During the DCCT/EDIC follow-up period, intensive treatment reduced the risk of nonfatal myocardial infarction, stroke, or death from cardiovascular disease by 57 percent (95 confidence interval, 12 to 79 percent; p=0.02). Reference The DCCT/EDIC Study Research Group. New England Journal of Medicine, 353:2643-2653, December 22, 2005. * * * * * * * * HPS研究中糖尿病人群分析 N=5963 Lancet 2003; 361: 2005-16 Benefit (SE) per 1000 allocated simvastatin –1 (6) 13 (8) 34 (9) 47 (10) 51 (15) 58 (48) Logrank p0.0001 Placebo-allocated Simvastatin-allocated 糖尿病人目标调脂水平 糖尿病人调脂治疗预防心血管病建议 调脂治疗是糖尿病人预防冠心病必不可少的治疗措施 治疗主要是针对降低 LDL－C 对于已有冠心病者治疗目标值为 LDL－C＜2.6mmol/L 降脂治疗首选他汀类，但对于TG增高明显者，可考虑贝特类药物 血糖水平与心血管事件发生密切相关 Ann Intern Med.2004;141:413-420. 血糖水平与心血管事件 强化血糖控制可降低I型糖尿病人心血管事件发生率---DCCT/EDIC 研究 N Engl J Med 2005: 353:2643-2653. Conventional Intensive 非致死性心梗, 卒中, or 心血管死亡 DCCT/EDIC 研究结果 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Years from Study Entry 0.00 0.02 0.04 0.06 0.08 0.10 0.12 Cumulative Incidence Risk reduction 57% 95% CI: 12% to 79% P = 0.02 N Engl J Med 2005: 353:2643-2653. Cumulative Incidence Years from Study Entry 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Risk reduction 42% 95% CI: 9% to 63% P = 0.02 0.12 0.10 0.08 0.06 0.04 0.02 0.00 Conventional Intensive 任意心血管事件终点 N Engl J Med 2005: 353:2643-2653. DCCT/EDIC 研究结果 强化血糖控制预防粥样硬化 -- DCCT/EDIC 随访6年颈动脉IMT变化 = 第二/三个四分位数, 横线= 中位数,“+” =均数 颈内动脉 颈总动脉 糖尿病组 非糖尿病对照组 男性 女性 男性 女性 P0.001 P=0.003 P0.00