Division of Endocrinology and Molecular Medicine, University of Kentucky, Wethington Building, Room 575, 900 South Limestone Street, Lexington, KY 40536-0200, USA.
Nat Rev Cardiol. 2010 Jul;7(7):369-75. doi: 10.1038/nrcardio.2010.35. Epub 2010 Apr 20.
Cardiovascular complications constitute the major cause of morbidity and mortality in patients with diabetes. The Diabetes Control and Complications Trial (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS) provided consistent evidence that intensive glycemic control prevents the development and progression of microvascular complications in patients with type 1 or type 2 diabetes. However, whether intensive glucose lowering also prevents macrovascular disease and major cardiovascular events remains unclear. Extended follow-up of participants in these studies demonstrated that intensive glycemic control reduced the long-term incidence of myocardial infarction and death from cardiovascular disease. By contrast, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial, and Veterans Affairs Diabetes Trial (VADT) results suggested that intensive glycemic control to near normoglycemia had either no, or potentially even a detrimental, effect on cardiovascular outcomes. This article discusses the effects of intensive glycemic control on cardiovascular disease, and examines key differences in the design of these trials that might have contributed to their disparate findings. Recommendations from the current joint ADA, AHA, and ACCF position statement on intensive glycemic control and prevention of cardiovascular disease are highlighted.
心血管并发症是糖尿病患者发病率和死亡率的主要原因。糖尿病控制和并发症试验（DCCT）和英国前瞻性糖尿病研究（UKPDS）提供了一致的证据，表明强化血糖控制可预防 1 型或 2 型糖尿病患者微血管并发症的发生和进展。然而，强化血糖降低是否也能预防大血管疾病和主要心血管事件仍不清楚。这些研究参与者的延长随访表明，强化血糖控制降低了心肌梗死和心血管疾病死亡的长期发生率。相比之下，心血管风险控制行动研究（ACCORD）、糖尿病和血管疾病行动：Preterax 和 Diamicron 改良释放对照评估（ADVANCE）试验以及退伍军人事务糖尿病试验（VADT）的结果表明，将血糖控制到接近正常水平对心血管结局既没有影响，甚至可能产生不利影响。本文讨论了强化血糖控制对心血管疾病的影响，并研究了这些试验设计中的关键差异，这些差异可能导致了它们的不同发现。强调了当前美国糖尿病协会、美国心脏协会和美国心脏病学会基金会联合发布的关于强化血糖控制和预防心血管疾病的立场声明中的建议。
