Denver VA Medical Center, Clermont Street, Denver, Colorado 80220, USA.
J Clin Endocrinol Metab. 2011 Aug;96(8):2367-76. doi: 10.1210/jc.2010-3011. Epub 2011 May 18.
Recent prospective clinical trials have failed to confirm a unique benefit from normalization of glycemia on cardiovascular disease outcomes, despite evidence from basic vascular biology, epidemiological, and cohort studies.
The literature was searched using the http://www.ncbi.nlm.nih.gov search engine including over 20 million citations on MEDLINE (1970 to present). Keyword searches included: atherosclerosis, cardiovascular, and glucose. Epidemiological, cohort, and interventional data on cardiovascular disease outcomes and glycemic control were reviewed along with analysis of recent reviews on this topic.
High glucose activates a proatherogenic phenotype in all cell types in the vessel wall including endothelial cells, vascular smooth muscle cells, inflammatory cells, fibroblasts, and platelets, leading to a feedforward atherogenic response. EPIDEMIOLOGICAL AND COHORT STUDIES: Epidemiological and cohort evidence indicates a clear and consistent correlation of glycemia with cardiovascular disease. A recent report of over 25,000 subjects with diabetes in the Swedish National Diabetes Registry verifies this relationship in contemporary practice. Interventional Studies: Prospective randomized interventions targeting a hemoglobin A1c of 6-6.5% for cardiovascular disease prevention failed to consistently decrease cardiovascular events or all-cause mortality.
Basic vascular biology data plus epidemiological and cohort evidence would predict that glucose control should impact cardiovascular events. Prospective clinical trials demonstrate that current strategies that improve blood glucose do not achieve this goal but suggest that a period of optimal control may confer long-term cardiovascular disease benefit. Clinicians should target a hemoglobin A1c of 7% for the prevention of microvascular complications, individualized to avoid hypoglycemia.
尽管基础血管生物学、流行病学和队列研究都有证据，但最近的前瞻性临床试验未能证实血糖正常化对心血管疾病结局有独特益处。
使用 http://www.ncbi.nlm.nih.gov 搜索引擎对文献进行搜索，其中包括 MEDLINE（1970 年至今）上的超过 2000 万条引文。关键词搜索包括：动脉粥样硬化、心血管和葡萄糖。对心血管疾病结局和血糖控制的流行病学、队列和干预数据进行了审查，并对该主题的最新综述进行了分析。
高血糖会激活血管壁中所有细胞类型的促动脉粥样硬化表型，包括内皮细胞、血管平滑肌细胞、炎症细胞、成纤维细胞和血小板，导致反馈性动脉粥样硬化反应。流行病学和队列研究：流行病学和队列研究证据表明，血糖与心血管疾病之间存在明确而一致的相关性。最近对瑞典国家糖尿病登记处超过 25000 名糖尿病患者的报告在当代实践中证实了这种关系。干预研究：针对血红蛋白 A1c 为 6-6.5%的心血管疾病预防的前瞻性随机干预未能一致降低心血管事件或全因死亡率。
基础血管生物学数据加上流行病学和队列研究证据表明，血糖控制应该会影响心血管事件。前瞻性临床试验表明，目前改善血糖的策略并未达到这一目标，但表明最佳控制期可能会带来长期的心血管疾病益处。临床医生应将血红蛋白 A1c 控制在 7%以预防微血管并发症，具体目标应根据避免低血糖来个体化确定。
