Sander G E, Wilklow F E, Giles T D
Section of Cardiology, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA.
Minerva Cardioangiol. 2004 Dec;52(6):491-503.
The metabolic abnormalities associated with diabetes mellitus result in macrovascular and microvascular complications in multiple organ systems; it is the cardiovascular impact that accounts for the greatest morbidity and mortality associated with this disease. Heart failure, both with reduced and preserved systolic function, is a major complication, arising from the frequent associations with coronary atherosclerosis, hypertension, and a specific heart muscle dysfunction (cardiomyopathy) that occurs independently of coronary artery disease. Hyperglycemia, insulin resistance, and hypertension, together with activation of both circulating and tissue renin-angiotensin-aldosterone systems, contribute to structural fibrosis and autonomic neuropathy. Thus it becomes imperative to identify cardiac abnormalities early in the course of both type 1 and type 2 diabetes in order to allow early and aggressive intervention to control glucose and blood pressure and to normalize blood lipid profiles. Patients with diabetes should be treated to secondary prevention targets, including blood pressure less than 130/80 mm Hg and LDL less than 100 mg/dL. Angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, certain calcium channel blockers, statins, and aspirin have all been demonstrated to significantly reduce cardiovascular morbidity and mortality in patients with diabetes.
与糖尿病相关的代谢异常会导致多器官系统出现大血管和微血管并发症；心血管方面的影响是该疾病相关发病率和死亡率的主要原因。收缩功能降低和保留的心力衰竭都是主要并发症，这是由于其常与冠状动脉粥样硬化、高血压以及一种独立于冠状动脉疾病发生的特定心肌功能障碍（心肌病）相关。高血糖、胰岛素抵抗和高血压，以及循环和组织肾素 - 血管紧张素 - 醛固酮系统的激活，会导致结构纤维化和自主神经病变。因此，在1型和2型糖尿病病程早期识别心脏异常变得至关重要，以便进行早期积极干预来控制血糖和血压，并使血脂水平正常化。糖尿病患者应接受二级预防目标治疗，包括血压低于130/80 mmHg和低密度脂蛋白低于100 mg/dL。血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂、β受体阻滞剂、某些钙通道阻滞剂、他汀类药物和阿司匹林均已被证明可显著降低糖尿病患者的心血管发病率和死亡率。
