糖尿病心血管疾病的非降脂治疗与临床评价课件.ppt

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1、ClinicalEvaluationandNonlipidTreatmentofCoronaryArteryDiseaseintheDiabeticPatientPrevalenceofAsymptomaticCADinDiabetesMellitusKoistinenMJ.BMJ1990;301:92-95.Type2Type1ControlsNakaMetal.AmHeartJ1992;123:46-53.Type2ControlsMiSADGroup.AmJCardiol1997;79:134-139.Type2RutterMK

2、etal.AmJCardiol1999;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%

3、65%40%58%55%9%11%9%12.1%5.3%6.4%——35%43%IndicationsforCardiacTestinginDiabeticPatientsTypicaloratypicalcardiacsymptomsRestingECGsuggestiveofischemiaorinfarctionPeripheralorcarotidocclusivearterialdiseaseSedentarylifestyleorplantobeginavigorousexerciseprogramTwoormore

4、oftheriskfactorslistedbelow-Totalcholesterol>240mg/dL,LDLcholesterol>160mg/dL,orHDLcholesterol<35mg/dL-Bloodpressure>140/90mmHg-Smoking-FamilyhistoryofprematureCAD-Positivemicro/macroalbuminuriaFactorsLimitingAccuracyofNoninvasive"Stress"TestsforCADHypertensiveCardiomyopa

5、thyDiabeticCardiomyopathyAutonomicCardiomyopathyRenalInsufficiencyMicrovascularDysfunctionBenefitsofEarlyDetectionofCADImplementmoreaggressiveCHDpreventionregimenInitiateanti-ischemicmedicationsIdentifypatientswhowouldbenefitfromrevascularizationEducatepatientstorecognizec

6、oronarysymptomsKannelWBetal.AmHeartJ1991;121:1268-1273.BloodPressureandCVD:FraminghamHeartStudyAge-adjustedCVEventRate/1,000SystolicBP(mmHg)105135165195SystolicBP(mmHg)105135165195Age-adjustedCVEventRate/1,00024503877591199017415312348367456113NoGlucoseIntoleranceGlucoseIn

7、toleranceNoGlucoseIntoleranceGlucoseIntoleranceMENWOMENUKPDSGroup.Lancet1998;352:837-853.EffectofGlycemicControlintheUKProspectiveDiabetesStudy(UKPDS)Anydiabetesrelated*MIStrokePVDMicrovascular40.914.75.61.18.64617.451.611.40.0290.0520.520.150.00991116––25(rate/1000ptyrs)

8、*CombinedmicrovascularandmacrovasculareventsIntensive%Decrease(rate/1000ptyrs)PConventi