Tuomilehto Jaakko
Diabetes and Genetic Epidemiology Unit, National Public Health Institute, Mannerheimintie 166, 00300 Helsinki, Finland.
Diabetes Res Clin Pract. 2003 Jul;61 Suppl 1:S27-34. doi: 10.1016/s0168-8227(03)00125-6.
Efforts to reduce the burden of coronary heart disease (CHD) associated with type 2 diabetes should include increased emphasis on preventing progression to diabetes in individuals with impaired glucose tolerance. Recent large-scale studies have shown that lifestyle intervention can reduce progression to diabetes by nearly 60%. Dyslipidaemia is a risk factor for CHD in diabetic patients. Accumulation of evidence indicating significant reductions in CHD risk with statin treatment to lower low-density lipoprotein (LDL)-cholesterol has led to the recommendation that reduction of LDL-cholesterol be considered the highest priority in treating diabetic dyslipidaemia; additional aims of treatment include raising high-density lipoprotein (HDL)-cholesterol and reducing triglyceride levels. In a recent trial of rosuvastatin alone or combined with fenofibrate in diabetic patients with combined hyperlipidaemia, rosuvastatin 40 mg monotherapy produced marked beneficial changes in LDL-cholesterol (-47%), HDL-cholesterol (+6%) and triglycerides (-30%), with the combination of lower-dose rosuvastatin (10 mg) and fenofibrate producing a significantly greater triglyceride reduction (-47%) and comparable changes in other lipid measures. Combination therapies for dyslipidaemia may be the key to optimizing CHD risk reduction in type 2 diabetes.
减轻与2型糖尿病相关的冠心病负担的努力应包括更加重视预防糖耐量受损个体发展为糖尿病。近期的大规模研究表明，生活方式干预可使糖尿病进展风险降低近60%。血脂异常是糖尿病患者冠心病的一个危险因素。越来越多的证据表明，使用他汀类药物治疗以降低低密度脂蛋白（LDL）胆固醇可显著降低冠心病风险，这使得人们建议将降低LDL胆固醇视为治疗糖尿病血脂异常的首要任务；治疗的其他目标包括提高高密度脂蛋白（HDL）胆固醇水平和降低甘油三酯水平。在最近一项针对合并高脂血症的糖尿病患者单独使用瑞舒伐他汀或联合非诺贝特的试验中，40mg瑞舒伐他汀单药治疗使LDL胆固醇（降低47%）、HDL胆固醇（升高6%）和甘油三酯（降低30%）产生了显著的有益变化，低剂量瑞舒伐他汀（10mg）与非诺贝特联合使用使甘油三酯降低幅度更大（降低47%），其他血脂指标变化相当。血脂异常的联合治疗可能是优化2型糖尿病患者冠心病风险降低的关键。
