Savage P J
Epidemiology and Biometry Program, National Heart, Lung, and Blood Institute, Bethesda, MD 20892-7934, USA.
Ann Intern Med. 1996 Jan 1;124(1 Pt 2):123-6. doi: 10.7326/0003-4819-124-1_part_2-199601011-00008.
Cardiovascular disease is a major causes of morbidity and mortality in patients with non-insulin-dependent diabetes mellitus (NIDDM). With an increase in the number of older diabetic persons, an increase in U.S. minority populations with high rates of diabetes, and the proven success of new methods to reduce microvascular complications, the importance of diabetic macrovascular complications will increase. The relative effectiveness of different treatments to reduce the incidence of diabetic cardiovascular complications is poorly understood. In addition to relative efficacy, issues related to patient burden and the economic cost of different treatments must be considered. Some of the information needed to improve therapy therapy will be available soon from ongoing clinical trials. Obtaining definitive answers to other questions, especially those related to the relative benefit of intensive glucose level control compared with control of other known cardiovascular disease risk factors, will require additional studies. Although several questions unique to diabetic patients remain unanswered, results of previous clinical trials done among largely nondiabetic participants can be used to develop interim recommendations for cardiovascular disease prevention. Until definitive guidelines for prevention are established, combining aggressive therapy for known cardiovascular disease risk factors with efforts to normalize the glucose level offers the best chance to reduce the higher risk for cardiovascular disease associated with NIDDM.
心血管疾病是非胰岛素依赖型糖尿病（NIDDM）患者发病和死亡的主要原因。随着老年糖尿病患者数量的增加、美国糖尿病高发的少数族裔人口的增多以及新方法在减少微血管并发症方面已被证实的成功，糖尿病大血管并发症的重要性将会增加。人们对不同治疗方法降低糖尿病心血管并发症发生率的相对有效性了解甚少。除了相对疗效外，还必须考虑与患者负担和不同治疗的经济成本相关的问题。正在进行的临床试验将很快提供一些改善治疗所需的信息。要获得其他问题的明确答案，尤其是那些与强化血糖水平控制相对于控制其他已知心血管疾病危险因素的相对益处相关的问题，则需要进行更多研究。尽管糖尿病患者特有的几个问题仍未得到解答，但以前在主要为非糖尿病参与者中进行的临床试验结果可用于制定心血管疾病预防的临时建议。在确定预防的明确指南之前，将针对已知心血管疾病危险因素的积极治疗与使血糖水平正常化的努力相结合，为降低与NIDDM相关的较高心血管疾病风险提供了最佳机会。
