Zellweger Michael J
Department of Cardiology, University Hospital, Basel, Switzerland.
Herz. 2006 May;31(3):240-5. doi: 10.1007/s00059-006-2790-1.
The prevalence of obesity and diabetes is increasing rapidly. Coronary artery disease (CAD) represents the leading cause of death in diabetic patients. Diabetic patients are at a two- to fourfold risk of cardiovascular mortality compared with their nondiabetic counterparts. Silent myocardial ischemia more often occurs in diabetics than in nondiabetics. In general, the prevalence of silent CAD varies depending on the test used for patient screening and on the patient population screened. The prevalence of silent CAD is 6-23% in low-risk diabetic patients. In high-risk diabetic patients the prevalence may be as high as 60%. Over the last years it has been well recognized that silent CAD is not different from symptomatic CAD with respect to prognosis and adverse events. Particular diabetic patients therefore might benefit from routine CAD screening. CAD could be diagnosed at an earlier stage of disease and be treated accordingly. Myocardial perfusion SPECT, stress echocardiography and possibly computed tomography are emerging as effective screening tools beyond risk stratification by risk factor scoring systems alone. There are few studies suggesting that early intervention by medical or also revascularization strategies could lead to a better outcome in diabetic patients with evidence of silent CAD.
肥胖和糖尿病的患病率正在迅速上升。冠状动脉疾病（CAD）是糖尿病患者的主要死因。与非糖尿病患者相比，糖尿病患者心血管死亡风险高出两到四倍。无症状心肌缺血在糖尿病患者中比非糖尿病患者更常见。一般来说，无症状CAD的患病率因用于患者筛查的检测方法以及所筛查的患者群体而异。低风险糖尿病患者中无症状CAD的患病率为6%-23%。在高风险糖尿病患者中，患病率可能高达60%。在过去几年中，人们已经充分认识到，就预后和不良事件而言，无症状CAD与有症状CAD并无不同。因此，特定的糖尿病患者可能会从常规CAD筛查中受益。CAD可以在疾病的早期阶段被诊断出来，并据此进行治疗。心肌灌注单光子发射计算机断层扫描（SPECT）、负荷超声心动图以及可能的计算机断层扫描正在成为超越单纯通过危险因素评分系统进行风险分层的有效筛查工具。很少有研究表明，对于有证据显示无症状CAD的糖尿病患者，通过药物或血运重建策略进行早期干预可能会带来更好的结果。
