Betteridge John
Department of Medicine, Royal Free and University College Medical School, Middlesex Hospital, London, United Kingdom.
Am J Med. 2005 Dec;118 Suppl 12A:10-5. doi: 10.1016/j.amjmed.2005.09.013.
The incidence of type 2 diabetes mellitus is expected to increase dramatically over the next decade. Patients with type 2 diabetes are at a much greater risk for cardiovascular disease (CVD) than are nondiabetic individuals. Consequently, the treatment of CVD risk factors is a healthcare priority in this patient population. Dyslipidemia is a major cardiovascular (CV) risk factor in patients with type 2 diabetes, and it is characterized by elevated triglyceride levels, low high-density lipoprotein (HDL) cholesterol levels, and a preponderance of small, dense low-density lipoprotein (LDL) particles. Subgroup analyses of clinical trial data suggest that treatment of the entire range of lipid abnormalities may reduce CV risk in this patient population. The 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) are the best therapy for LDL cholesterol reduction. A number of statin trials have shown significant CV risk reduction through LDL cholesterol lowering in subgroups of patients with diabetes. The recently published Collaborative Atorvastatin Diabetes Study (CARDS), a placebo-controlled trial conducted solely in patients with type 2 diabetes, terminated 2 years earlier than its anticipated length owing to the significant reduction in number of CV events observed in patients randomized to receive low-dose atorvastatin versus placebo. These results suggest that low-dose statin therapy with atorvastatin results in significant reduction of CV events in patients with type 2 diabetes without prior CVD or high LDL cholesterol levels. Based on this evidence, patients with type 2 diabetes may be candidates for statin therapy regardless of LDL cholesterol level and in the absence of a previous CV event.
预计在未来十年内，2型糖尿病的发病率将急剧上升。与非糖尿病个体相比，2型糖尿病患者患心血管疾病（CVD）的风险要高得多。因此，治疗CVD危险因素是该患者群体医疗保健的优先事项。血脂异常是2型糖尿病患者的主要心血管（CV）危险因素，其特征是甘油三酯水平升高、高密度脂蛋白（HDL）胆固醇水平降低以及小而密的低密度脂蛋白（LDL）颗粒占优势。临床试验数据的亚组分析表明，治疗所有类型的血脂异常可能会降低该患者群体的CV风险。3-羟基-3-甲基戊二酰辅酶A（HMG-CoA）还原酶抑制剂（他汀类药物）是降低LDL胆固醇的最佳疗法。多项他汀类药物试验表明，通过降低LDL胆固醇，糖尿病患者亚组的CV风险显著降低。最近发表的阿托伐他汀糖尿病协作研究（CARDS）是一项仅在2型糖尿病患者中进行的安慰剂对照试验，由于随机接受低剂量阿托伐他汀与安慰剂的患者中观察到的CV事件数量显著减少，该试验比预期提前2年结束。这些结果表明，对于没有先前CVD或高LDL胆固醇水平的2型糖尿病患者，低剂量阿托伐他汀治疗可显著降低CV事件。基于这一证据，无论LDL胆固醇水平如何，且在没有先前CV事件的情况下，2型糖尿病患者可能是他汀类药物治疗的候选者。
