糖尿病对心血管危险的影响

ImpactofDiabetesonCardiovascularRiskC.RichardContiM.D.MACCOct16,2004GWICCBeijing,PRCImage(Prevention/Vascular)OverlapofFourCommonConditions25KBFileType:GIFSourceACCELimageprovidedbytheAmericanCollegeofCardiologyFoundationDiabetesandCardiovascularRisk•AnAssociationbetweendiabetesmellitusandanginapectoriswasfirstdescribedin1883,shortlyafteritwashypothesizedthatanginapectoriswasduetoatherosclerosis•VergelyP.Del’anginedepoitrinedanssesrapportsaveclediabete.Gazhedbdened(ser2)1883;20:364ClinicalTrial(INVEST)BloodPressureControlIINNVVEESSTT11yyeeaarrSBP140SBP130DBP90DBP85Non-Diabetics67%89%Diabetics62%90%Diabetics34%83%NCEP(ATPIII)DefinitionofMetabolicSyndrome•3ofthese5factorshavetobepresent:–Increasedwaistcircumference(102cminmenor88cminwomen)–Hypertriglyceridemia(150mg/dl)–LowHDL-cholesterol(40mg/mlinmenand50mg/mlinwomen)–Hypertension(BP130/80mmHg)–Fastingserumglucose110mg/dl(ValidatedwiththeWOSCOPSdata)ImageAbnormalitiesAssociatedWiththeMetabolicSyndrome114KBFileType:JPGSourceACCELimageprovidedbytheAmericanCollegeofCardiologyFoundationIGTInsulinresistanceIncreasedinsulinresistanceFastingglucoseHyperglycemiaInsulinsecretionHyperinsulinemia,thenb-cellfailureAdaptedfromInternationalDiabetesCenter(IDC),Minneapolis,MinnesotaInsulinResistanceand-CellDysfunctionAreFundamentaltoType2DiabetesPost-prandialglucoseAbnormalglucosetoleranceNormalType2Diabetes50%ofType2DiabetesPatientsHaveComplicationsattheTimeofDiagnosisRetinopathy,glaucomaorcataractsNephropathyNeuropathyMICROVASCULARMACROVASCULARCerebrovasculardiseaseCoronaryheartdiseasePeripheralvasculardiseaseUKProspectiveDiabetesStudyGroup.UKPDS33.Lancet1998;352:837–853MicroalbuminuriainMetabolicSyndrome(MS)Patients020406080MSNormoglycemicMSGlucoseIntoleranceMSDiabetesMicroalbuminuriamg/24hp=0.001ANOVASeguraetalJASN,2004RydenL,etal.Lancet2002;GlucoseandCVRisk(OralGlucoseToleranceTest)AllpatientshadexperiencedanMI;n=300AtHospitalDischarge12MonthsLaterType2diabetics24%36%Impairedglucosetolerance41%32%Normalglucosetolerance35%32%AgeandgenderadjustedCHD,CVDandtotalmortalityinUSadultswithmetabolicsyndromewithandwithoutdiabetesandpreexistingCVD.n=6255Followup133patientyears.MaliketalCirc2004;110:1245-1250PrevalenceoftheMetabolicSyndromeAmongU.S.Adults•Unadjustedprevalence21.8%•Age-adjustedprevalence23.7%–Prevalenceincreasedwithage–MexicanAmericanshadthehighestprevalence(31.9%)FordES,etal.JAMA2002;287:356–9Seven-yearincidenceinaFinnish-basedcohort*P0.001vsnopriorMI†P0.001vsnodiabetesAdaptedfromHaffnerSM.NewEnglJMed1998;339:229–234RiskofMyocardialInfarctionIsIncreasedinType2Diabetes0%20%40%RiskofFatalorNon-FatalMyocardialInfarctionNopriormyocardialinfarctionPriormyocardialinfarctionNon-DiabeticSubjectsType2DiabeticSubjects*n=1,304*††60%69890169CausesofMortalityinDiabeticPatientsPanzramG.Diabetologia1987;30:123–31%DeathsinDiabeticPatientsNotSpecifiedOthersTuberculosisAccident/SuicideGangreneRenalInsufficiencyDiabeticComaInfectionsTumoursStrokeMyocardialInfarction010203040PredictedGrowthinthePrevalenceofDiabetesWHO.TheWorldHealthReport,199701020304050607080AfricaAmericasEasternMedEuropeSoutheastAsiaWesternPacificYear199520002025EstimatedPrevalenceInMillionsCoronaryEventRatesforDiabeticandNondiabeticParticipantsWoscops