Haffner Steven M
Department of Medicine, Division of Clinical Epidemiology, University of Texas Health Science Center at San Antonio, DTL, Room 5.606U, Mail code 7873, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA.
Diabetes Res Clin Pract. 2003 Jul;61 Suppl 1:S9-S18. doi: 10.1016/s0168-8227(03)00122-0.
There is accumulating evidence that insulin resistance in the pre-diabetic state is associated with the presence of additional cardiovascular risk factors and increased incidence of cardiovascular disease (CVD). There is also accumulating evidence indicating that chronic sub-clinical inflammation as measured by such inflammatory markers as C-reactive protein (CRP) is associated with insulin resistance and other features of the insulin resistance syndrome, increased risk of development of type 2 diabetes and increased cardiovascular event risk. Insulin-sensitizing agents may have greater effects in reducing cardiovascular risk than secretagogues in the pre-diabetic state, and glitazones have been found to decrease CRP levels in patients with diabetes. Statins also reduce CRP levels. Efforts to reduce CVD should include increased emphasis on improving glycaemic control, preventing development of diabetes and addressing cardiovascular risk factors in the pre-diabetic state.
越来越多的证据表明，糖尿病前期状态下的胰岛素抵抗与其他心血管危险因素的存在以及心血管疾病（CVD）发病率的增加有关。也有越来越多的证据表明，用C反应蛋白（CRP）等炎症标志物衡量的慢性亚临床炎症与胰岛素抵抗及胰岛素抵抗综合征的其他特征、2型糖尿病发生风险增加以及心血管事件风险增加有关。在糖尿病前期状态下，胰岛素增敏剂在降低心血管风险方面可能比促分泌剂有更大的作用，并且已发现格列酮类药物可降低糖尿病患者的CRP水平。他汀类药物也可降低CRP水平。降低心血管疾病的努力应包括更加重视改善血糖控制、预防糖尿病的发生以及解决糖尿病前期状态下的心血管危险因素。
