Grover Steven A, Coupal Louis, Zowall Hanna, Weiss Thomas W, Alexander Charles M
Centre for the Analysis of Cost-Effective Care, The Montreal General Hospital, Montreal, Quebec, Canada.
Am J Med. 2003 Aug 1;115(2):122-8. doi: 10.1016/s0002-9343(03)00303-6.
Diabetes mellitus is associated with an increased risk of cardiovascular disease. We compared the clinical effects of treating dyslipidemia in patients who had diabetes mellitus but no diagnosed cardiovascular disease with the effects of similar treatment in patients who had cardiovascular disease but no diabetes mellitus.
We estimated the number of adults (ages 30 to 74 years) requiring lipid therapy using data from the third National Health and Nutrition Examination Survey and current lipid treatment guidelines. Using the Cardiovascular Life Expectancy Model, we estimated the mean increase in life expectancy that would result from lowering low-density lipoprotein cholesterol levels by 35% and increasing high-density lipoprotein cholesterol levels by 8% based on results from the Scandinavian Simvastatin Survival Study.
The mean number of years of life saved ranged from 3 to 3.4 years for men with diabetes versus 2.4 to 2.7 years for men with cardiovascular disease. In women, the estimated benefits were 1.6 to 2.4 years for those with diabetes versus 1.6 to 2.1 years for those with cardiovascular disease. Total population benefits were also substantial for patients with diabetes (25.4 million person-years of life saved) and those with cardiovascular disease (16.0 million person-years of life saved).
The clinical benefits of treating dyslipidemia in patients with diabetes should be at least equivalent to, if not more substantial than, the benefits observed among those with cardiovascular disease.
糖尿病与心血管疾病风险增加相关。我们比较了治疗无确诊心血管疾病的糖尿病患者血脂异常的临床效果与治疗无糖尿病的心血管疾病患者类似治疗的效果。
我们使用第三次全国健康和营养检查调查的数据以及当前血脂治疗指南，估算了需要进行血脂治疗的成年人（30至74岁）数量。基于斯堪的纳维亚辛伐他汀生存研究的结果，我们使用心血管预期寿命模型，估算了将低密度脂蛋白胆固醇水平降低35%并将高密度脂蛋白胆固醇水平提高8%所导致的预期寿命平均增加量。
糖尿病男性患者的平均挽救生命年数为3至3.4年，而心血管疾病男性患者为2.4至2.7年。在女性中，糖尿病患者的估计获益为1.6至2.4年，而心血管疾病患者为1.6至2.1年。糖尿病患者（挽救2540万人年生命）和心血管疾病患者（挽救1600万人年生命）的总体人群获益也相当可观。
治疗糖尿病患者血脂异常的临床获益如果不比心血管疾病患者所观察到的获益更显著，至少也应相当。
