替米沙坦与代谢综合征

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1、WillaHsueh,M.D.ProfessorofMedicineChief,DivisionofEndocrinology,Diabetes,andHypertensionUCLADavidGeffenSchoolofMedicineLosAngeles,CaliforniaCardiovascularRiskContinuum:ImplicationsofInsulinResistanceandDiabetesDiabetesisavasculardisease:AngiotensinIIhasbeenimplicatedinboththede

2、velopmentofdiabetesanditscomplicationsDiabetesInsulin-mediatedglucoseuptakeSkeletalmuscleAdiposeFFAInflammatoryAdipokinesLiverGlucoseproductionPancreasInsulinproductionAtherosclerosisCAD,Stroke,PeripheralvasculardiseaseDiabeticNephropathyAlbuminexcretionDiabeticRetinopat

3、hyVEGFneovascularizationDiastolicdysfunction,interstitialfibrosisheartfailureCardiomyopathyIL6PAI-1TNFadiponectinleptinInsulinsensitivityinsulinresistanceVascularinflammationendothelialdysfunctionangiotensinogenFFAAdipocyteAdipokinesMediateInsulinResistanceandInfla

4、mmationProgressionofAtherosclerosisinInsulinResistanceEndothelialDysfunctionTG,HDL-CsdLDL-CHypertensionUricAcidPAI-1InflammationThrombosisOxidationAtherosclerosisAtherosclerosisUnstableplaqueInflammation,FibrosisCapThrombosisandRuptureEventHyperinsulinemiaMetabolicSyndromeImpair

5、edGlucoseToleraneType2DiabetesHsuehWA,LawR.AJC,2003InsulinResistanceForindividualsbornin2000:Males–32.8%Females–38.5%Estimatedlossoflifeexpectancyifdiagnosedatage40:Males–11.6yearsFemales–14.3yearsNarayanJAMA2003LifetimeRiskforDiabetesintheUS13NH313NH313NH3Dipyridamole(0.56mg/kg

6、)135’RestQuinonesetalAnnInternMed.,2004;140:700-8NoninvasiveMeasurementsofMyocardialBloodFlow:PositronEmissionTomography0’25’45’70’90’115’CPTDIPApproachesthatImproveCoronaryVasomotorFunctioninInsulinResistance:Insulinsensitizers:TZDs,PPARligandsAT1receptorblockers:ARBsGlucosec

7、ontrolintype2diabetes:MetforminVALUE(ValsartanAntihypertensiveLong-TermUseEvaluation):23%lessnewonsetdiabeteswithvalsartancomparedtoamlodipineinpatientswithhypertensionHOPE(HeartOutcomesPreventionEvaluation):32%lessnewonsetdiabeteswithramiprilcomparedtoplaceboinhighcardiovascula

8、rriskpatientsLIFE(LosartanInterventionforEndpoi