糖尿病综合管理新视点.pptVIP

近年的糖尿病干预研究多是多因素干预 “传统”心血管危险因素的“非传统”认识 FPG PPG HbA1c SBP DBP PP LDL-C TG HDL-C ? Central blood pressure Quality of lipoproteins 小 结 各种危险因素和事件紧密关联，需用整体的视点看待糖尿病 对糖尿病患者，综合控制危险因素是唯一可行出路 关注“血糖达标” 关注“糖尿病病人” Objectives The purpose of this study was to examine the association of diabetic retinopathy with incident heart failure (HF). Background Microvascular disease might play a more prominent role in the pathogenesis of diabetic cardiomyopathy, a major cause of HF in diabetes. Whether diabetic retinopathy, a microvascular complication of diabetes, predicts HF is unclear. Methods A population-based study included 1,021 middle-aged type 2 diabetic persons with normal renal function and free of clinical coronary heart disease or HF at baseline. Diabetic retinopathy signs were graded from retinal photographs. Incident HF events were prospectively identified from hospital stay and death records. Results There were 125 (12.8%) participants with diabetic retinopathy. After 9-year follow-up, 106 (10.1%) participants developed incident HF events. Persons with retinopathy were more likely to develop HF (cumulative incidence of 21.6%) than those without retinopathy (cumulative incidence of 8.5%). After controlling for age, gender, race, smoking, diabetes duration, insulin use, blood pressure, lipid profile, and other risk factors, participants with retinopathy had more than 2.5-fold higher risk of developing HF than those without retinopathy (hazard ratio [HR] 2.71; 95% confidence interval [CI] 1.46 to 5.05). This association remained significant after further adjustments for glycemic control, carotid atherosclerosis, and serum markers of endothelial dysfunction (HR 2.20, 95% CI 1.08 to 4.47). Conclusions The presence of diabetic retinopathy signifies an excess risk of HF, independent of known risk factors. This further supports a contribution of microvascular disease to the development of HF in people with diabetes. 糖尿病综合管理新视点 肖新华 北京协和医院 对糖尿病的认识 我国的皇帝内经详细描述糖尿病症状，并命名为