Circulation. 2022 Mar;145(9):e722-e759. doi: 10.1161/CIR.0000000000001040. Epub 2022 Jan 10.
Cardiovascular disease remains the leading cause of death in patients with diabetes. Cardiovascular disease in diabetes is multifactorial, and control of the cardiovascular risk factors leads to substantial reductions in cardiovascular events. The 2015 American Heart Association and American Diabetes Association scientific statement, "Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence," highlighted the importance of modifying various risk factors responsible for cardiovascular disease in diabetes. At the time, there was limited evidence to suggest that glucose-lowering medications reduce the risk of cardiovascular events. At present, several large randomized controlled trials with newer antihyperglycemic agents have been completed, demonstrating cardiovascular safety and reduction in cardiovascular outcomes, including cardiovascular death, myocardial infarction, stroke, and heart failure. This AHA scientific statement update focuses on (1) the evidence and clinical utility of newer antihyperglycemic agents in improving glycemic control and reducing cardiovascular events in diabetes; (2) the impact of blood pressure control on cardiovascular events in diabetes; and (3) the role of newer lipid-lowering therapies in comprehensive cardiovascular risk management in adults with diabetes. This scientific statement addresses the continued importance of lifestyle interventions, pharmacological therapy, and surgical interventions to curb the epidemic of obesity and metabolic syndrome, important precursors of prediabetes, diabetes, and comorbid cardiovascular disease. Last, this scientific statement explores the critical importance of the social determinants of health and health equity in the continuum of care in diabetes and cardiovascular disease.
心血管疾病仍然是糖尿病患者的主要死因。糖尿病的心血管疾病是多因素的，控制心血管危险因素可显著减少心血管事件。2015 年美国心脏协会和美国糖尿病协会的科学声明“根据最新证据更新 2 型糖尿病成人心血管疾病预防”强调了改变导致糖尿病心血管疾病的各种危险因素的重要性。当时，只有有限的证据表明降糖药物可以降低心血管事件的风险。目前，已经完成了几项针对新型抗高血糖药物的大型随机对照试验，这些试验表明了心血管安全性以及降低了心血管结局，包括心血管死亡、心肌梗死、卒中和心力衰竭。本次 AHA 科学声明更新的重点是：(1)新型抗高血糖药物在改善糖尿病患者血糖控制和减少心血管事件方面的证据和临床应用；(2)血压控制对糖尿病心血管事件的影响；(3)新型降脂治疗在糖尿病患者综合心血管风险管理中的作用。本科学声明强调了生活方式干预、药物治疗和手术干预在遏制肥胖和代谢综合征这一糖尿病和心血管疾病重要前驱疾病的流行中的持续重要性。最后，本科学声明探讨了健康的社会决定因素和健康公平在糖尿病和心血管疾病护理连续体中的重要性。
