Department of Medicine, Yale-New Haven Hospital, New Haven, CT.
Department of Medicine, Yale-New Haven Hospital, New Haven, CT; Section of Endocrinology, Yale School of Medicine, New Haven, CT.
Trends Cardiovasc Med. 2016 Feb;26(2):165-79. doi: 10.1016/j.tcm.2015.05.005. Epub 2015 May 21.
Epidemiologic analyses have established a clear association between diabetes and macrovascular disease. Vascular dysfunction caused by metabolic abnormalities in patients with diabetes is associated with accelerated atherosclerosis and increased risk of myocardial infarction (MI), stroke, and peripheral arterial disease. Patients with diabetes are at two to four fold higher CV risk as compared to non-diabetic individuals, and CVD remains the leading cause of mortality in patients with this condition. One strategy to reduce CVD burden in patients with diabetes has been to focus on controlling the major metabolic abnormality in this condition, namely hyperglycemia. However, this has not been unequivocally demonstrated to reduced CV events, in contrast to controlling other CVD risk factors linked to hyperglycemia, such as blood pressure, dyslipidemia, and platelet dysfunction. However, In contradistinction, accrued data from a number of large, randomized clinical trials in both type 1 (T1DM) and type 2 diabetes (T2DM) over the past 3 decades have proven that more intensive glycemic control retards the onset and progression of microvascular disease. In this review, we will summarize the key glucose-lowering CV outcomes trials in diabetes, provide an overview of the different drugs and their impact on the CV system, and describe our approach to management of the frequently encountered patient with T2DM and coronary artery disease (CAD) and/or heart failure (HF).
流行病学分析已经明确确立了糖尿病与大血管疾病之间的关联。糖尿病患者代谢异常引起的血管功能障碍与动脉粥样硬化加速和心肌梗死（MI）、中风和外周动脉疾病风险增加有关。与非糖尿病个体相比，糖尿病患者的心血管风险增加了 2 至 4 倍，心血管疾病仍然是该疾病患者死亡的主要原因。减少糖尿病患者心血管疾病负担的一种策略是专注于控制这种疾病的主要代谢异常，即高血糖。然而，与控制与高血糖相关的其他心血管疾病风险因素（如血压、血脂异常和血小板功能障碍）相比，这并没有明确证明可以减少心血管事件。然而，相反，过去 30 年来，在 1 型（T1DM）和 2 型糖尿病（T2DM）中进行的多项大型随机临床试验积累的数据证明，更严格的血糖控制可延缓微血管疾病的发生和进展。在这篇综述中，我们将总结糖尿病中降低血糖的心血管结局试验，概述不同药物及其对心血管系统的影响，并描述我们处理经常遇到的 T2DM 合并冠心病（CAD）和/或心力衰竭（HF）患者的方法。
