Pillarisetti Sivaram
Cardiovasc Hematol Agents Med Chem. 2012 Sep;10(3):185-9. doi: 10.2174/187152512802651079.
The major cause of death and complications in patients with type 2 diabetes is cardiovascular disease. Cardiovascular complications that are often associated with diabetes include heart failure, acute myocardial infarction (MI), peripheral vascular disease, and cerebrovascular disease. More than 60% of all patients with type 2 diabetes die of cardiovascular disease, and an even greater percentage have serious complications. The impact of glucose lowering on cardiovascular complications is a hotly debated issue and recent large clinical trials, the Action in Diabetes and Vascular Disease (ADVANCE), Action to Control Cardiovascular Risk in Diabetes (ACCORD) and Veterans Affairs Diabetes Trial (VADT) reported no significant decrease in cardiovascular events with intensive glucose control. Risk remains high even after correcting diabetes-associated dyslipidemia (high triglycerides and low HDL). Several mechanisms are likely to contribute to the accelerated atherosclerosis and increased cardiovascular disease risk seen in type 2 diabetics. Of these, postprandial hyperglycemia/lipemia, insulin resistance and inflammation may be the most important and under controlled contributing factors to vascular disease. The goal of this thematic issue is to address limitations of current therapies and review emerging research and therapeutic approaches that target inflammation, insulin resistance and other pathological mechanisms that contribute to cardiovascular disease in diabetes.
2型糖尿病患者死亡及并发症的主要原因是心血管疾病。常与糖尿病相关的心血管并发症包括心力衰竭、急性心肌梗死（MI）、外周血管疾病和脑血管疾病。超过60%的2型糖尿病患者死于心血管疾病，更高比例的患者有严重并发症。血糖降低对心血管并发症的影响是一个备受争议的问题，近期的大型临床试验，如糖尿病与血管疾病行动（ADVANCE）、糖尿病心血管风险控制行动（ACCORD）以及退伍军人事务部糖尿病试验（VADT）报告称，强化血糖控制并未使心血管事件显著减少。即使纠正了与糖尿病相关的血脂异常（高甘油三酯和低高密度脂蛋白），风险仍然很高。几种机制可能导致2型糖尿病患者加速动脉粥样硬化并增加心血管疾病风险。其中，餐后高血糖/高血脂、胰岛素抵抗和炎症可能是导致血管疾病的最重要且未得到控制的因素。本期专题的目标是解决当前治疗方法的局限性，并综述针对炎症、胰岛素抵抗及其他导致糖尿病心血管疾病的病理机制的新兴研究和治疗方法。
