Naito Ryo, Miyauchi Katsumi
Heart Center, Juntendo University Urayasu Hospital.
Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine.
Int Heart J. 2017 Aug 3;58(4):475-480. doi: 10.1536/ihj.17-191. Epub 2017 Jul 14.
Type 2 diabetes mellitus (T2DM) is a major risk factor of coronary artery diseases (CAD). Clinical outcomes in CAD with T2DM are poor despite improvement in medications and intervention devices. Coronary artery bypass grafting (CABG) is superior to percutaneous coronary intervention (PCI) in treating diabetic patients with multivessel coronary artery diseases (MVD). However, selecting a revascularization strategy should depend not only on the lesion complexity but also on the patient's background and comorbidities. In addition, comprehensive risk management with medical and non-pharmacological therapies is important, as is confirmation of whether risk managements are appropriately achieved. Recently, novel anti-diabetic drugs have been demonstrated to have effectiveness in reducing cardiovascular events, which was independent of their glucose-lowering effect. Furthermore, non-pharmacological interventions using exercise and diet during the earlier stages of abnormal glucose metabolism might be beneficial in preventing the development or progression of T2DM and reducing the incidence of cardiovascular events.
2型糖尿病(T2DM)是冠状动脉疾病(CAD)的主要危险因素。尽管药物和介入装置有所改进,但合并T2DM的CAD患者临床预后仍较差。在治疗患有多支冠状动脉疾病(MVD)的糖尿病患者时,冠状动脉旁路移植术(CABG)优于经皮冠状动脉介入治疗(PCI)。然而,选择血运重建策略不仅应取决于病变的复杂性,还应考虑患者的背景和合并症。此外,药物和非药物治疗的综合风险管理很重要,确认风险管理是否得到适当落实也很重要。最近,新型抗糖尿病药物已被证明在降低心血管事件方面有效,这与其降糖作用无关。此外,在糖代谢异常的早期阶段采用运动和饮食等非药物干预措施,可能有助于预防T2DM的发生或发展,并降低心血管事件的发生率。