Stirban Alin O, Tschoepe Diethelm
Heart and Diabetes Center, Ruhr-University Bochum, Bad Oeynhausen, Germany.
Diabetes Care. 2008 Feb;31 Suppl 2:S215-21. doi: 10.2337/dc08-s257.
Cardiovascular complications are mainly responsible for the high morbidity and mortality in people with diabetes. The awareness of physicians for the importance of primary prevention increased lately and numerous strategies have been developed. The spectrum ranges from pharmacologic treatment to vitamins and dietetic interventions. Some interesting concepts such as focusing on exogenous advanced glycation end products have emerged, but definitive results on their clinical relevance are still lacking. A major problem of the primary prevention is the choice of the method applied for screening, the criteria used to classify risk patients, as well as the choice of therapy. Guidelines provide goals to be achieved and offer alternatives for treatment, but the medical decision has to be made on an individualized basis. In this overview, we will comprehensively focus on the most important pathomechanisms and clinically relevant approaches, aiming at the early diagnosis and treatment of diabetes along with coronary heart disease. When primary prevention fails, we advocate a more aggressive treatment of critically ill patients, followed by optimal secondary prevention meeting on-target goals precisely.
心血管并发症是导致糖尿病患者高发病率和高死亡率的主要原因。近来，医生对一级预防重要性的认识有所提高，并已制定了许多策略。其范围涵盖从药物治疗到维生素和饮食干预。一些有趣的概念已经出现，比如关注外源性晚期糖基化终产物，但关于它们临床相关性的确切结果仍未得出。一级预防的一个主要问题是用于筛查的方法选择、用于对高危患者进行分类的标准以及治疗方法的选择。指南提供了要实现的目标并给出了治疗选择，但医疗决策必须基于个体化做出。在本综述中，我们将全面聚焦于最重要的病理机制和临床相关方法，旨在早期诊断和治疗糖尿病以及冠心病。当一级预防失败时，我们主张对重症患者采取更积极的治疗，随后精确地进行符合目标的最佳二级预防。
