针对糖尿病患者残余心血管疾病风险的多个领域。
Targeting multiple domains of residual cardiovascular disease risk in patients with diabetes.
机构信息
Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
Department of Medicine, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts, USA.
出版信息
Curr Opin Cardiol. 2020 Sep;35(5):517-523. doi: 10.1097/HCO.0000000000000762.
PURPOSE OF REVIEW
There has been a recent resurgence of diabetes-related cardiovascular complications after years of steady improvement. This review highlights established and emerging contemporary secondary prevention approaches that lower the risk of atherosclerotic and nonatherosclerotic cardiovascular disease events among patients with diabetes.
RECENT FINDINGS
Secondary prevention therapies modify residual risk targets, including cardiometabolic pathways, lipoproteins, thrombosis, and inflammation. Large-scale clinical trials of sodium-glucose cotransporter-2 inhibitors have demonstrated significant reductions in hospitalization for heart failure. Glucagon-like peptide-1 receptor agonists have reduced the risk of major adverse cardiovascular events. Recent clinical trials provide evidence supporting the use of nonstatin lipid-lowering therapies, novel antiplatelet and anticoagulant strategies, and antiinflammatory strategies in select cases.
SUMMARY
Therapeutic approaches targeting multiple distinct pathways have been shown to improve cardiometabolic risk in diabetes. Individual patient characteristics and consideration of residual risk targets may help guide selection of comprehensive secondary prevention approaches.
目的综述
在多年稳定改善之后，糖尿病相关心血管并发症最近又再次出现。本篇综述重点介绍了现有的和新兴的二级预防方法，这些方法降低了糖尿病患者发生动脉粥样硬化和非动脉粥样硬化性心血管疾病事件的风险。
最近的发现
二级预防治疗可改变残余风险指标，包括心脏代谢途径、脂蛋白、血栓形成和炎症。钠-葡萄糖共转运蛋白-2 抑制剂的大型临床试验表明，心力衰竭住院的风险显著降低。胰高血糖素样肽-1 受体激动剂降低了主要不良心血管事件的风险。最近的临床试验提供了证据，支持在某些情况下使用非他汀类降脂治疗、新型抗血小板和抗凝策略以及抗炎策略。
总结
针对多个不同途径的治疗方法已被证明可改善糖尿病患者的心脏代谢风险。个体患者的特征和对残余风险指标的考虑可能有助于指导综合二级预防方法的选择。
Zotero 插件