Nadal Josep Franch, Gutiérrez Pedro Conthe
EAP Raval Sud-ICS (Barcelona) y redGDPS, Barcelona, España.
Sección de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, España.
Med Clin (Barc). 2013 Sep;141 Suppl 2:7-13. doi: 10.1016/S0025-7753(13)70057-5.
Diabetes mellitus, especially type 2, is a metabolic disease involving the coexistence of several cardiovascular risk factors. Affected patients are therefore at high cardiovascular risk (2-3 times higher than that of men in the general population and 2-6 times higher than that of women). Cardiovascular disease is the main cause of death in the diabetic population, followed by cancer. Cardiovascular risk cannot be compared between diabetic patients and persons who have already shown one or more manifestations of cardiovascular disease (such as myocardial infarction). Single risk factors should be evaluated in combination with other risk factors and a person's cardiovascular risk should be individually assessed. Cardiovascular risk assessment in patients with diabetes through current calculations methods is complex because their ability to predict risk in individuals is very low. Studies such as that by Steno have demonstrated the validity of a comprehensive strategy to control all the risk factors present in persons with type 2 diabetes mellitus, which can reduce the development of micro- and macrovascular complications and mortality by almost 50%. The present article reviews each of the classical cardiovascular risk factors (hypertension, dyslipidemia, smoking, obesity, sedentariness) in relation to diabetes, as well as their recommended targets and the benefits of their control. In view of the above, a comprehensive approach is recommended to control the multiple risk factors that can coexist in persons with type 2 diabetes mellitus.
糖尿病，尤其是2型糖尿病，是一种涉及多种心血管危险因素并存的代谢性疾病。因此，受影响的患者心血管风险很高（比普通人群中的男性高2至3倍，比女性高2至6倍）。心血管疾病是糖尿病患者的主要死因，其次是癌症。糖尿病患者与已经出现一种或多种心血管疾病表现（如心肌梗死）的人之间的心血管风险无法进行比较。单一危险因素应与其他危险因素结合评估，并且应单独评估一个人的心血管风险。通过当前的计算方法对糖尿病患者进行心血管风险评估很复杂，因为这些方法预测个体风险的能力非常低。像斯滕诺（Steno）研究所表明的那样，全面控制2型糖尿病患者中存在的所有危险因素的策略是有效的，这可以将微血管和大血管并发症的发生以及死亡率降低近50%。本文回顾了与糖尿病相关的每种经典心血管危险因素（高血压、血脂异常、吸烟、肥胖、久坐不动），以及它们的推荐目标和控制这些因素的益处。鉴于上述情况，建议采用综合方法来控制2型糖尿病患者中可能并存的多种危险因素。
