Taskinen M R
Baillieres Clin Endocrinol Metab. 1990 Dec;4(4):743-75. doi: 10.1016/s0950-351x(05)80078-3.
Currently our knowledge of the role of lipid abnormalities as risk factors for CHD in diabetes is insufficient. We need to define exact risk parameters to target correctly the therapy of lipid disorders and to outline optimum therapeutic strategies. Therefore it is necessary to identify quantitative and qualitative abnormalities of lipoproteins and apoproteins which signify the risk of CHD and to define their predictive power in prospective trials. Obviously we need to know more about the pathophysiology of lipid abnormalities and the action of insulin. Because diabetic patients carry a high inherent risk of CHD, target values recommended for non-diabetic populations may not be optimal for diabetic populations, but should be lower. To date no primary or secondary intervention trials in diabetic populations have been carried out to show that the lowering of lipid values (serum and LDL cholesterol) will reduce the risk of CHD morbidity or mortality or will prevent the progression of CHD in diabetes. Since hypertriglyceridaemia and low HDL levels are typical abnormalities in NIDDM it is a unique target group to test whether lowering of triglycerides and raising of HDL cholesterol levels will reduce the risk of CHD. Therefore there is a pressing need for clinical trials in both IDDM and NIDDM to provide adequate information on the benefits of lipid-lowering therapy and to confirm treatment strategies.
目前，我们对于脂质异常作为糖尿病患者冠心病危险因素所起作用的了解还不够充分。我们需要确定确切的风险参数，以便正确地针对脂质紊乱进行治疗，并制定最佳治疗策略。因此，有必要识别出预示冠心病风险的脂蛋白和载脂蛋白的定量及定性异常，并在前瞻性试验中确定它们的预测能力。显然，我们需要更多地了解脂质异常的病理生理学以及胰岛素的作用。由于糖尿病患者本身患冠心病的风险很高，推荐给非糖尿病患者群体的目标值对糖尿病患者群体可能并非最佳，而应该更低。迄今为止，尚未在糖尿病患者群体中开展一级或二级干预试验来表明降低脂质水平（血清和低密度脂蛋白胆固醇）会降低冠心病发病或死亡风险，或者会阻止糖尿病患者冠心病的进展。由于高甘油三酯血症和低高密度脂蛋白水平是非胰岛素依赖型糖尿病的典型异常情况，所以它是一个独特的目标群体，可用于测试降低甘油三酯水平和提高高密度脂蛋白胆固醇水平是否会降低冠心病风险。因此，迫切需要在胰岛素依赖型糖尿病和非胰岛素依赖型糖尿病患者中都开展临床试验，以提供关于降脂治疗益处的充分信息，并确认治疗策略。
