Lenaers M
Service de Cardiologie, Hôpital Erasme et Polyclinique du Lothier, U.L.B.
Rev Med Brux. 2000 Jun;21(3):149-56.
Diabetic patients have a higher prevalence of hypertension, dyslipidemia and obesity. However, diabetes is by itself a major independent risk factor for cardiovascular disease. About two-thirds of total mortality are due to diabetic macroangiopathy. It is characterised by accelerated atherosclerosis, with more severe, more extensive and more diffuse lesions, as compared with nondiabetic patients. Patients with diabetes present more frequently acute pulmonary oedema despite similar infarct sizes than do nondiabetic patients. They are more frequently at risk for ventricular dysfunction, for ventricular aneurysm and for congestive heart failure. At the time of diagnosis of type 2 diabetes, more than 50% of patients have pre-existing coronary heart disease, probably related to painless ischemia, caused by an autonomic denervation of the heart in diabetic patients. International recommendations suggest that all diabetic patients should be evaluated at least annually for the development or progression of risk factors that would prompt cardiac testing. The standard bicycle exercise test should be chosen in an asymptomatic patient with only one other risk factor and with a normal resting ECG. For all other diabetic patients, stress echocardiography or stress myocardial perfusion imaging should be preferably chosen.
糖尿病患者中高血压、血脂异常和肥胖的患病率较高。然而，糖尿病本身就是心血管疾病的主要独立危险因素。约三分之二的总死亡率归因于糖尿病大血管病变。其特征是动脉粥样硬化加速，与非糖尿病患者相比，病变更严重、更广泛且更弥漫。尽管梗死面积相似，但糖尿病患者比非糖尿病患者更常出现急性肺水肿。他们更常面临心室功能障碍、心室壁瘤和充血性心力衰竭的风险。在2型糖尿病诊断时，超过50%的患者已有冠心病，这可能与无痛性缺血有关，而无痛性缺血是由糖尿病患者心脏自主神经去神经支配引起的。国际指南建议，所有糖尿病患者应至少每年评估是否出现或进展为提示需进行心脏检查的危险因素。对于仅有一项其他危险因素且静息心电图正常的无症状患者，应选择标准的自行车运动试验。对于所有其他糖尿病患者，应首选负荷超声心动图或负荷心肌灌注成像。
