Simon Kornél, Dobó Edit, Szépvölgyi Anikó, Szalczer Estilla, Kazup Szilvia, Papp László, Varga Erika
Siófok Város Kórház-Rendelőintézete, Belgyógyászati Osztály, Siófok.
Orv Hetil. 2011 Aug 21;152(34):1353-61. doi: 10.1556/OH.2011.29169.
Despite advances in the management of cardiovascular diseases, the incidence of cardiovascular diseases is increasing both in developed and developing world. This phenomenon is associated with the worldwide pandemic of obesity and type 2 diabetes; both are related to the life style of urbanization. The association between life conduct of civilization and chronic stress resulting in augmentation of cardiovascular risk is detailed. Therapeutic policy practiced nowadays (polypill administration, achieving target values) in order to reduce cardiovascular risk is criticized. Primary causal role of chronic stress and life style, and secondary resultant nature of cardiovascular risk factors are stressed out in the pathogenesis of increased cardiovascular risk; therefore, limited value of an approach focusing on the management of cardiovascular risk factors, instead of targeting the primary cause, i.e. chronic stress and life conduct is emphasized. A short account is given about the similarities and dissimilarities in the pathogenesis of macro- and microangiopathy. The primary causal role of chronic stress in fetal and adult diabetes, furthermore possible triggers evoking chronic stress is discussed. Supportive experimental and clinical data are reported about the nature of basic metabolic dysregulation (dysmetabolism) in the pathogenesis of metabolic syndrome and type 2 diabetes. Besides the well documented significance of ischemic clinical manifestations of diabetes, the role of non-ischemic diabetic cardiomyopathy as an independent risk factor in evoking the total burden of cardiovascular risk in diabetes is emphasized. In reducing the cardiovascular risk in diabetics the management of high blood pressure and dyslipidemia is more effective compared to that of hyperglycemia. Besides managing cardiovascular risk factors, the successful treatment of dysmetabolism is importantly needed to eliminate the total excessive cardiovascular risk in diabetes. In order to achieve this goal the potential role of metabolic promoters is stressed out.
尽管在心血管疾病管理方面取得了进展，但心血管疾病的发病率在发达国家和发展中国家都在上升。这种现象与全球肥胖和2型糖尿病大流行有关；两者都与城市化的生活方式有关。文中详细阐述了文明生活行为与慢性应激之间的关联，这种关联导致心血管风险增加。当前为降低心血管风险所实施的治疗策略（复方药丸给药、达到目标值）受到了批评。强调了慢性应激和生活方式在心血管风险增加的发病机制中的主要因果作用，以及心血管危险因素的次要结果性质；因此，强调了一种侧重于管理心血管危险因素而非针对主要原因（即慢性应激和生活行为）的方法的有限价值。简要介绍了大血管和微血管病变发病机制中的异同。讨论了慢性应激在胎儿和成人糖尿病中的主要因果作用，以及可能引发慢性应激的因素。报告了支持性的实验和临床数据，以说明代谢综合征和2型糖尿病发病机制中基本代谢失调（代谢紊乱）的性质。除了糖尿病缺血性临床表现的充分记录的重要性外，还强调了非缺血性糖尿病心肌病作为引发糖尿病心血管风险总负担的独立危险因素的作用。在降低糖尿病患者的心血管风险方面，控制高血压和血脂异常比控制高血糖更有效。除了管理心血管危险因素外，成功治疗代谢紊乱对于消除糖尿病中过度的心血管总风险也非常重要。为了实现这一目标，强调了代谢促进剂的潜在作用。
