Perdigoto Ana L, Young Lawrence H, Inzucchi Silvio E
Department of Internal Medicine, Section of Endocrinology.
Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
Cardiovasc Endocrinol. 2017 May 17;6(2):55-61. doi: 10.1097/XCE.0000000000000110. eCollection 2017 Jun.
Insulin resistance, a fundamental pathophysiological abnormality in patients with type 2 diabetes, is associated with increased cardiovascular (CV) disease risk. In diabetes management, the macrovascular impact of antihyperglycemic agents that do not improve insulin sensitivity has generally been disappointing. In contrast, glucose-lowering drugs that work as insulin sensitizing agents have been postulated to reduce CV complications. The data to support this hypothesis have, however, been inconsistent. The impact of thiazolidinediones on macrovascular events is of particular interest. In this review, we discuss the results of trials reporting CV outcomes in patients treated with thiazolidinediones. We focus on the findings of the recent Insulin Resistance Intervention after Stroke trial that demonstrated a beneficial effect of pioglitazone on CV outcomes in stroke patients with insulin resistance. We discuss the Insulin Resistance Intervention after Stroke results and its implications for clinical practice. We discuss the selective use of pioglitazone as secondary prevention to reduce CV risk in insulin resistant patients.
胰岛素抵抗是2型糖尿病患者的一种基本病理生理异常，与心血管（CV）疾病风险增加相关。在糖尿病管理中，那些不能改善胰岛素敏感性的降糖药物对大血管的影响通常令人失望。相比之下，被认为可作为胰岛素增敏剂的降糖药物据推测能够减少心血管并发症。然而，支持这一假说的数据并不一致。噻唑烷二酮类药物对大血管事件的影响尤其令人关注。在本综述中，我们讨论了报告噻唑烷二酮类药物治疗患者心血管结局的试验结果。我们重点关注近期的卒中后胰岛素抵抗干预试验的结果，该试验证明吡格列酮对胰岛素抵抗的卒中患者的心血管结局具有有益作用。我们讨论了卒中后胰岛素抵抗干预试验的结果及其对临床实践的意义。我们还讨论了选择性使用吡格列酮作为二级预防措施以降低胰岛素抵抗患者心血管风险的问题。
