Vijan Sandeep, Hayward Rodney A
Veterans Affairs Health Services Research and Development Center for Practice Management and Outcomes Research, University of Michigan, Ann Arbor 48105, USA.
Ann Intern Med. 2004 Apr 20;140(8):650-8. doi: 10.7326/0003-4819-140-8-200404200-00013.
Cardiovascular disease is the primary complication and cause of death in patients with type 2 diabetes mellitus. Modification of cardiovascular risk factors may improve patient outcomes.
To evaluate the effectiveness of pharmacologic lipid-lowering therapy on outcomes in type 2 diabetes mellitus.
Review of the literature.
Randomized trials evaluating clinical outcomes of lipid-lowering treatment in patients with diabetes.
Studies were identified by searching the Cochrane Library, MEDLINE, meta-analyses, review articles, and inquiries to experts. The Cochrane Library and MEDLINE searches were done in September 2002. Data were abstracted onto standardized forms by a single reviewer and were confirmed by a second reviewer.
Meta-analysis of 6 primary prevention studies showed that lipid-lowering medications reduced risks for cardiovascular outcomes (relative risk, 0.78 [95% CI, 0.67 to 0.89]; absolute risk reduction, 0.03 [CI, 0.01 to 0.04] in 4.3 years of treatment); 1 major cardiovascular event was prevented by treating 34 to 35 patients. Meta-analysis of 8 studies of secondary prevention showed a similar relative risk (0.76 [CI, 0.59 to 0.93]) but more than twice the absolute risk reduction (0.07 [CI, 0.03 to 0.12] in 4.9 years of treatment) and a number needed to treat for benefit of 13 to 14. Most studies compared a lipid-lowering drug with placebo but did not evaluate the effect of reaching specific cholesterol levels. The benefit of lipid lowering with a fixed dose of a statin appeared to be similar regardless of starting cholesterol levels.
Target cholesterol levels and the effectiveness of dose titration (or the use of multiple agents) have not been rigorously examined.
In patients with type 2 diabetes, treatment with lipid-lowering agents reduces cardiovascular risk. Most patients, including those whose baseline low-density lipoprotein cholesterol levels are below 2.97 mmol/L (<115 mg/dL), and possibly below 2.59 mmol/L (<100 mg/dL), benefit from statins. Moderate doses of these drugs suffice in most patients with diabetes.
心血管疾病是2型糖尿病患者的主要并发症及死亡原因。改变心血管危险因素可能改善患者预后。
评估药物降脂治疗对2型糖尿病患者预后的有效性。
文献综述。
评估糖尿病患者降脂治疗临床结局的随机试验。
通过检索考克兰图书馆、医学期刊数据库、荟萃分析、综述文章以及咨询专家来确定研究。考克兰图书馆和医学期刊数据库的检索于2002年9月进行。数据由一名审阅者提取到标准化表格上，并由另一名审阅者确认。
对6项一级预防研究的荟萃分析表明，降脂药物降低了心血管事件风险（相对风险，0.78 [95%可信区间，0.67至0.89]；在4.3年的治疗中，绝对风险降低0.03 [可信区间，0.01至0.04]）；治疗34至35名患者可预防1次主要心血管事件。对8项二级预防研究的荟萃分析显示相对风险相似（0.76 [可信区间，0.59至0.93]），但绝对风险降低超过两倍（在4.9年的治疗中为0.07 [可信区间，0.03至0.12]），且受益所需治疗人数为13至14。大多数研究将一种降脂药物与安慰剂进行比较，但未评估达到特定胆固醇水平的效果。无论起始胆固醇水平如何，固定剂量他汀类药物的降脂益处似乎相似。
目标胆固醇水平以及剂量滴定（或使用多种药物）的有效性尚未得到严格检验。
在2型糖尿病患者中，使用降脂药物治疗可降低心血管风险。大多数患者，包括那些基线低密度脂蛋白胆固醇水平低于2.97 mmol/L（<115 mg/dL），甚至可能低于2.59 mmol/L（<100 mg/dL）的患者，均可从他汀类药物中获益。这些药物的中等剂量对大多数糖尿病患者就足够了。
