Hovens Marcel M C, Tamsma Jouke T, Beishuizen Edith D, Huisman Menno V
Department of General Internal Medicine, Leiden University Medical Centre, PO Box 9600, Leiden, C01-R, 2300 RC, the Netherlands.
Drugs. 2005;65(4):433-45. doi: 10.2165/00003495-200565040-00001.
Morbidity and mortality in patients with type 2 diabetes mellitus is largely dominated by the occurrence of cardiovascular disease (CVD). Treatment of known risk factors of CVD has proven to be beneficial in terms of reduction in risk of major CVD events in the general population. Recent trials have provided information on the treatment of hyperglycaemia, hypertension, dyslipidaemia and platelet aggregation in the patient with type 2 diabetes. Strict glycaemic control is not associated with a significant reduction in CVD risk, although new hypoglycaemic agents may offer additional benefits. In contrast, it has been demonstrated that treatment of hypertension and dyslipidaemia significantly reduce cardiovascular risk. Meticulous control of blood pressure to a level < or =130/80 mm Hg, preferably using renin-angiotensin system-modulating agents, is of proven value. Use of HMG-CoA reductase inhibitors (statins) as low-density lipoprotein (LDL)-cholesterol-lowering therapy, initiated at a level of > or =2.60 mmol/L is firmly established. Recent trials lend support to lowering the target level for LDL-cholesterol-lowering therapy to < or =1.81 mmol/L. Mainly based on risk analogy, international guidelines advocate the use of aspirin (acetylsalicylic acid) in the primary prevention of CVD in patients with type 2 diabetes. However, there is no support from large trials that the estimated 25% risk reduction in primary prevention in a high-risk population is the same in the subgroup with diabetes. An intensified approach in order to identify and treat cardiovascular risk factors in patients with type 2 diabetes, stratified to individual patients, is necessary to reduce the excess cardiovascular burden of these patients.
2型糖尿病患者的发病率和死亡率在很大程度上由心血管疾病（CVD）的发生所主导。事实证明，治疗已知的心血管疾病风险因素对于降低普通人群中主要心血管疾病事件的风险是有益的。最近的试验提供了有关2型糖尿病患者高血糖、高血压、血脂异常和血小板聚集治疗的信息。严格的血糖控制与心血管疾病风险的显著降低并无关联，尽管新型降糖药物可能会带来额外益处。相比之下，已经证明治疗高血压和血脂异常可显著降低心血管风险。将血压精确控制在≤130/80 mmHg的水平，最好使用调节肾素-血管紧张素系统的药物，已被证明具有价值。使用HMG-CoA还原酶抑制剂（他汀类药物）作为降低低密度脂蛋白（LDL）胆固醇的治疗方法，在LDL胆固醇水平≥2.60 mmol/L时开始使用已得到确立。最近的试验支持将降低LDL胆固醇治疗的目标水平降至≤1.81 mmol/L。主要基于风险类推，国际指南提倡在2型糖尿病患者心血管疾病的一级预防中使用阿司匹林（乙酰水杨酸）。然而，大型试验并未支持在糖尿病亚组中，高危人群一级预防中估计25%的风险降低是相同的这一观点。为了识别和治疗2型糖尿病患者的心血管危险因素，采取强化方法并根据个体患者进行分层，对于减轻这些患者过多的心血管负担是必要的。
