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预防心脏代谢综合征中的糖尿病和动脉粥样硬化。

Preventing Diabetes and Atherosclerosis in the Cardiometabolic Syndrome.

机构信息

Department of Internal Medicine, Section on Hospital Medicine, Trinitas Regional Medical Center, 225 Williamson St, Elizabeth City, NJ, 07202, USA.

Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.

出版信息

Curr Atheroscler Rep. 2021 Mar 9;23(4):16. doi: 10.1007/s11883-021-00913-8.

Abstract

PURPOSE OF REVIEW

Cardiometabolic syndrome is characterized by abdominal adiposity, insulin resistance, hypertension, and dyslipidemia. There is a growing burden of cardiometabolic disease in many parts of the world. This review highlights the critical preventive and therapeutic measures that need to be implemented to reduce the impact of cardiometabolic syndrome on cardiovascular health.

RECENT FINDINGS

Recent cardiovascular outcome trials demonstrated that newer glucose-lowering medications reduce cardiovascular and renal events in patients with type 2 diabetes mellitus (T2DM). These medications should be considered in patients with T2DM and atherosclerotic cardiovascular disease (ASCVD). These novel drugs may also play a role in primary prevention of cardiovascular disease (CVD) and renal disease in high-risk patients without T2DM. To manage dyslipidemia associated with cardiometabolic syndrome, in addition to lifestyle interventions and statin therapy, ezetimibe, and proprotein convertase subtilisin/Kexin type 9 (PCSK9), inhibitors can be used to reduce the risk of major adverse cardiovascular outcomes (MACE) especially in patients with T2DM and coronary artery disease (CAD). The residual risk of MACE in such a high-risk population can be further mitigated by treatment with an omega-3 fatty acid such as icosapent ethyl. Lifestyle modifications and the use of proven pharmacological therapies are essential for the prevention and progression of diabetes and ASCVD in those with the cardiometabolic syndrome.

摘要

目的综述

代谢综合征的特征为腹部肥胖、胰岛素抵抗、高血压和血脂异常。在世界许多地区,代谢相关心血管疾病的负担日益加重。本综述强调了需要实施的关键预防和治疗措施,以降低代谢综合征对心血管健康的影响。

最近的发现

最近的心血管结局试验表明,新型降糖药物可降低 2 型糖尿病(T2DM)患者的心血管和肾脏事件。对于合并动脉粥样硬化性心血管疾病(ASCVD)的 T2DM 患者,应考虑使用这些药物。这些新型药物可能在无 T2DM 的高危患者的心血管疾病(CVD)和肾脏疾病的一级预防中发挥作用。为了管理代谢综合征相关的血脂异常,除了生活方式干预和他汀类药物治疗外,还可以使用依折麦布和前蛋白转化酶枯草溶菌素 9(PCSK9)抑制剂,以降低主要不良心血管事件(MACE)的风险,尤其是在 T2DM 和冠心病(CAD)患者中。对于这种高危人群,用二十碳五烯酸乙酯等 ω-3 脂肪酸治疗可以进一步降低 MACE 的残余风险。生活方式的改变和已证实的药物治疗对于预防代谢综合征患者的糖尿病和 ASCVD 及其进展至关重要。

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