糖尿病心血管疾病的非降脂治疗与临床评价ppt课件

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1、ClinicalEvaluationandNonlipidTreatmentofCoronaryArteryDiseaseintheDiabeticPatientRichardNesto,MDPrevalenceofAsymptomaticCADinDiabetesMellitusKoistinenMJ.BMJ1990;301:92-95.Type2Type1ControlsNakaMetal.AmHeartJ1992;123:46-53.Type2ControlsMiSADGroup.AmJCardiol1997;79:134-139.Type2RutterMKetal.Am

2、JCardiol1999;83:27-31.Type2wmicroalbType2w/omicroalbLeAetal.AmJKidneyDis1994;24:65-71.Type1RenalTransplantHolleyJLetal.AmJMed1991;90:563-570.Type1&2RenalTransplantn=64n=72n=80n=142n=149n=925n=43n=43PositiveETTPositiveAngiography(thal201)36%24%9%31%30%12.1%65%40%58%55%9%11%9%12.1%5.3

3、%6.4%——35%43%IndicationsforCardiacTestinginDiabeticPatientsTypicaloratypicalcardiacsymptomsRestingECGsuggestiveofischemiaorinfarctionPeripheralorcarotidocclusivearterialdiseaseSedentarylifestyleorplantobeginavigorousexerciseprogramTwoormoreoftheriskfactorslistedbelow-Totalcholesterol>240mg/dL

4、,LDLcholesterol>160mg/dL,orHDLcholesterol<35mg/dL-Bloodpressure>140/90mmHg-Smoking-FamilyhistoryofprematureCAD-Positivemicro/macroalbuminuriaFactorsLimitingAccuracyofNoninvasive"Stress"TestsforCADHypertensiveCardiomyopathyDiabeticCardiomyopathyAutonomicCardiomyopathyRenalInsufficiencyMicrovasc

5、ularDysfunctionBenefitsofEarlyDetectionofCADImplementmoreaggressiveCHDpreventionregimenInitiateanti-ischemicmedicationsIdentifypatientswhowouldbenefitfromrevascularizationEducatepatientstorecognizecoronarysymptomsKannelWBetal.AmHeartJ1991;121:1268-1273.BloodPressureandCVD:FraminghamHeartStudyAg

6、e-adjustedCVEventRate/1,000SystolicBP(mmHg)105135165195SystolicBP(mmHg)105135165195Age-adjustedCVEventRate/1,00024503877591199017415312348367456113NoGlucoseIntoleranceGlucoseIntoleranceNoGlucoseIntoleranceGlucoseIntoleranceMENWOMENUKPDSGroup.Lancet1998;352:837-853.EffectofGlycemicControlintheUK

7、ProspectiveDiabetesStudy(UKPDS)Anydiabetesrelated*MIStrokePVDMicrovascular40.914.75.61.18.64617.451.611.40.0290.0520.520.150.00991116––25(rate/1000ptyrs)*CombinedmicrovascularandmacrovasculareventsIntensive%Decrease(rate/1000pt