Diabetes Division, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas.
Endocr Rev. 2019 Dec 1;40(6):1447-1467. doi: 10.1210/er.2018-00141.
Patients with type 2 diabetes mellitus (T2DM) are at high risk for macrovascular complications, which represent the major cause of mortality. Despite effective treatment of established cardiovascular (CV) risk factors (dyslipidemia, hypertension, procoagulant state), there remains a significant amount of unexplained CV risk. Insulin resistance is associated with a cluster of cardiometabolic risk factors known collectively as the insulin resistance (metabolic) syndrome (IRS). Considerable evidence, reviewed herein, suggests that insulin resistance and the IRS contribute to this unexplained CV risk in patients with T2DM. Accordingly, CV outcome trials with pioglitazone have demonstrated that this insulin-sensitizing thiazolidinedione reduces CV events in high-risk patients with T2DM. In this review the roles of insulin resistance and the IRS in the development of atherosclerotic CV disease and the impact of the insulin-sensitizing agents and of other antihyperglycemic medications on CV outcomes are discussed.
2 型糖尿病（T2DM）患者发生大血管并发症的风险很高，大血管并发症是主要的致死原因。尽管有效治疗了已确定的心血管（CV）危险因素（血脂异常、高血压、促凝状态），但仍存在大量未明的 CV 风险。胰岛素抵抗与一组被称为胰岛素抵抗（代谢）综合征（IRS）的心脏代谢危险因素有关。本文综述了大量证据，表明胰岛素抵抗和 IRS 导致 T2DM 患者的这种未明的 CV 风险。因此，用吡格列酮进行的 CV 结局试验表明，这种胰岛素增敏噻唑烷二酮可降低 T2DM 高危患者的 CV 事件。在本综述中，讨论了胰岛素抵抗和 IRS 在动脉粥样硬化性 CV 疾病发展中的作用，以及胰岛素增敏剂和其他抗高血糖药物对 CV 结局的影响。
