Bianchi Cristina, Miccoli Roberto, Penno Giuseppe, Del Prato Stefano
Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy.
Diabetes Care. 2008 Feb;31 Suppl 2:S208-14. doi: 10.2337/dc08-s256.
Cardiovascular disease accounts for a great majority of deaths in patients with type 2 diabetes. According to the World Health Organization, the prevalence of cardiovascular disease in diabetic patients ranges from 26 to 36%. Fatality rate after myocardial infarction is greater in diabetic patients, and overall prognosis after coronary heart disease is worse. Based on these observations, it has been proposed that diabetes should be considered as a coronary heart disease risk equivalent. If that is the case, prevention of diabetes and early intervention should be pursued. This view is supported by the notion that cardiovascular risk is already increased in people with impaired glucose tolerance. Moreover, higher-than-optimum blood glucose is a major cause of cardiovascular mortality in most world regions of the world. Whether dysglycemia is a marker for a more complex metabolic condition or may directly contribute to excess cardiovascular risk is still a matter of debate. However, experimental work has shown how increased glucose level can trigger multiple mechanisms of susceptibility to atherosclerosis, and diabetes prevention trials have indicated that along with reduction of the rate of conversion toward diabetes, significant improvement in cardiovascular risk factors occurs. Moreover, in the STOP-NIDDM trial, targeting postprandial glucose was associated with reduction in new cases of hypertension, myocardial infarction, and any cardiovascular events. In conclusion, dysglycemia should be included in the list of established cardiovascular risk factors and early treatment introduced in the attempt to improve cardiovascular morbidity and mortality.
心血管疾病是2型糖尿病患者死亡的主要原因。据世界卫生组织统计，糖尿病患者中心血管疾病的患病率在26%至36%之间。糖尿病患者心肌梗死后的死亡率更高，冠心病后的总体预后更差。基于这些观察结果，有人提出应将糖尿病视为冠心病的风险等同因素。如果是这样，就应该预防糖尿病并进行早期干预。糖耐量受损人群的心血管风险已经增加，这一观点支持了上述看法。此外，在世界上大多数地区，血糖水平高于最佳值是心血管疾病死亡的主要原因。血糖异常是更复杂代谢状况的标志物，还是可能直接导致心血管风险增加，这仍是一个有争议的问题。然而，实验研究表明，血糖水平升高如何引发动脉粥样硬化易感性的多种机制，糖尿病预防试验表明，随着向糖尿病转化率的降低，心血管危险因素也有显著改善。此外，在STOP-NIDDM试验中，针对餐后血糖与高血压、心肌梗死新发病例及任何心血管事件的减少相关。总之，血糖异常应被列入既定的心血管危险因素清单，并引入早期治疗以改善心血管疾病的发病率和死亡率。
