Yun Jae-Seung, Ko Seung-Hyun
Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Metabolism. 2021 Oct;123:154838. doi: 10.1016/j.metabol.2021.154838. Epub 2021 Jul 30.
With the advances in diabetes care, the trend of incident cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (T2DM) has been decreasing over past decades. However, given that CVD is still a major cause of death in patients with diabetes and that the risk of CVD in patients with T2DM is more than twice that in those without DM, there are still considerable challenges to the prevention of CVD in diabetes. Accordingly, there have been several research efforts to decrease cardiovascular (CV) risk in T2DM. Large-scale genome-wide association studies (GWAS) and clinical cohort studies have investigated the effects of factors, such as genetic determinants, hypoglycaemia, and insulin resistance, on CVD and can account for the unexplained CV risk in T2DM. Lifestyle modification is a widely accepted cornerstone method to prevent CVD as the first-line strategy in T2DM. Recent reports from large CV outcome trials have proven the positive CV effects of sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1RAs) in patients with high CVD risk. Overall, current practice guidelines for the management of CVD in T2DM are moving from a glucocentric strategy to a more individualised patient-centred approach. This review will discuss the current epidemiologic trends of CVD in T2DM and the risk factors linking T2DM to CVD, including genetic contribution, hypoglycaemia, and insulin resistance, and proper care strategies, including lifestyle and therapeutic approaches.
随着糖尿病治疗水平的提高，在过去几十年中，2型糖尿病（T2DM）患者中心血管疾病（CVD）的发病趋势一直在下降。然而，鉴于CVD仍然是糖尿病患者的主要死因，且T2DM患者发生CVD的风险是无糖尿病患者的两倍多，糖尿病患者CVD的预防仍然面临相当大的挑战。因此，已经有多项研究致力于降低T2DM患者的心血管（CV）风险。大规模全基因组关联研究（GWAS）和临床队列研究调查了遗传决定因素、低血糖和胰岛素抵抗等因素对CVD的影响，并可以解释T2DM中无法解释的CV风险。生活方式改变是预防CVD的一种广泛接受的基石方法，是T2DM的一线策略。大型CV结局试验的最新报告证实了钠-葡萄糖协同转运蛋白-2（SGLT-2）抑制剂和胰高血糖素样肽-1受体激动剂（GLP-1RAs）对高CVD风险患者的积极CV作用。总体而言，目前T2DM患者CVD管理的实践指南正从以葡萄糖为中心的策略转向更个体化的以患者为中心的方法。本综述将讨论T2DM患者CVD的当前流行病学趋势以及将T2DM与CVD联系起来的风险因素，包括遗传因素、低血糖和胰岛素抵抗，以及适当的护理策略，包括生活方式和治疗方法。
