糖尿病脂代謝紊亂及其與冠心病的關(guān)系講義-全文預(yù)覽
【正文】 TC LDLC (150) (220) (140) (150) (200) (120) (150) (180) (100) 表 4 我國(guó)高脂血癥防治的目標(biāo)水平[mmol/L(mg/dl)] ， 無(wú)動(dòng)脈粥樣硬化疾病 ， 無(wú)動(dòng)脈粥樣硬化疾病 或冠心病 注： ； ； ，屬于冠心病二級(jí)預(yù)防 降脂目標(biāo) (LDLC＜ 100mg/dl)： 臨床試驗(yàn)證據(jù) ? 他汀類臨床試驗(yàn) ? 治療 5年。159:2661–2667. CHD prevention trials with statins in diabetic subjects Subgroup analyses 4S: Incidence of MCE by glucose status MCE = major coronary events. Haffner SM, et al. Arch Intern Med. 1999。98:2513–2519。l228。 Prevention CARE Pravastatin 586 23% 25% 4S Simvastatin 202 32% 55% LIPID Pravastatin 782 25% 19% 4S reanalysis Simvastatin 483 32% 42% CHD risk CHD risk reduction reduction Study Drug n (overall) (diabetes) Adapted from Downs JR, et al. JAMA. 1998。chap 11. 0 % of deaths Ischemic Other Strictly Cancer Stroke Infection Other heart heart diabetes disease disease related 50 40 30 20 10 Type 2 diabetes and CHD: 7year incidence of fatal/nonfatal MI (East West Study) MI = myocardial infarction. * These patients had no prior MI at baseline. Haffner SM, et al. N Engl J Med. 1998。 簡(jiǎn)易分型法將高脂血癥分為高膽固醇血癥、高甘油三酯血癥和混合型高脂血癥 Causes of Secondary Dyslipidemias Hypercholesterolemia Hypertriglyceridemia Combined Hyperlipidemia Common disorders Hypothyroidism Diabetes Hypothyroidism Nephrotic syndrome Obesity Nephrotic syndrome Obstructive liver disease Alcohol Chronic renal failure Chronic renal failure Unmon disorders Pregnancy Myocardial infarction Acromegaly Anorexia nervosa Acute infection Liver disease Connective tissue diseases Nephrotic syndrome Pregnancy Bulimia Medications Thiazide diuretics bblockers Thiazide diuretics Retinoids Retinoids Glucocorticoids Glucocorticoids Oral estrogens Retinoids Cyclosporine Progestins Androgens WHY ? ?糖尿病冠心病的危害性 糖尿病冠心病的臨床特點(diǎn) ? 脂代謝紊亂在糖尿病冠心病中的地位 ? 糖尿病患者調(diào)脂治療的益處 大血管病變，微血管病變，其它方面 Mortality in people with diabetes Causes of death Geiss LS, et al. In: Diabetes in America. 2nd ed. 1995。 Prevention AFCAPS/TexCAPS Lovastatin 155 37% 43% 2176。r
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