Nesto Richard W
Department of Cardiovascular Medicine, Lahey Clinic Medical Center, Burlington, Massachusetts, USA.
Rev Cardiovasc Med. 2004 Winter;5(1):1-8.
Diabetes is a strong and independent risk factor for the development of heart failure, and once heart failure occurs, patients with diabetes have a much poorer prognosis than do those without diabetes. This difference has been explained by the existence of a distinct diabetic cardiomyopathy characterized by morphologic and structural changes to the myocardium and coronary vasculature. Despite diabetic cardiomyopathy, the pharmacologic treatment of heart failure in diabetic patients is similar to that in patients without diabetes, and in general, the clinical response of diabetic patients to drug therapies for heart failure is similar, if not superior, to that of nondiabetic patients. Subgroup analyses from large clinical studies have shown that angiotensin-converting enzyme inhibitors not only reduce mortality in diabetic patients with heart failure, but also reduce the incidence of heart failure in at-risk diabetic patients. B-Blockers remain underused in the diabetic population despite overwhelming evidence of their efficacy in treating heart failure in patients with diabetes.
糖尿病是发生心力衰竭的一个重要且独立的危险因素，一旦发生心力衰竭，糖尿病患者的预后比非糖尿病患者差得多。这种差异可通过存在一种独特的糖尿病性心肌病来解释，其特征为心肌和冠状血管的形态学和结构改变。尽管存在糖尿病性心肌病，但糖尿病患者心力衰竭的药物治疗与非糖尿病患者相似，总体而言，糖尿病患者对心力衰竭药物治疗的临床反应即使不优于非糖尿病患者，也与之相似。大型临床研究的亚组分析表明，血管紧张素转换酶抑制剂不仅可降低糖尿病心力衰竭患者的死亡率，还可降低高危糖尿病患者心力衰竭的发生率。尽管有大量证据表明β受体阻滞剂对治疗糖尿病患者的心力衰竭有效，但在糖尿病人群中其使用仍不足。
