關(guān)注心血管病殘余風(fēng)險(xiǎn)(編輯修改稿)
2024-11-04 13:44 本頁(yè)面
【文章內(nèi)容簡(jiǎn)介】 萬人失明 導(dǎo) 致成人 終 末期 腎病每年新增 44% Cardiovascular Disease 10名糖尿病患者中有 8人死于心血管事件 預(yù) 期壽命減少 510年 NIDDK, National Diabetes Statistics fact sheet. HHS, NIH, 2020. Diabetic Nephropathy Stroke Diabetic Neuropathy 糖尿病治療中相關(guān)殘余風(fēng)險(xiǎn) In the STENO2 study, intensive multifactorial intervention significantly reduced the development or progression of diabetesrelated microvascular disease, but failed to prevent this in many patients. Reason for this could being Residual Risk. JEANCHARLES FRUCHART, et al. Diabetes and Vascular Disease Research 2020 Does intensive therapy of type 2 diabetes help or harm? Seeking accord on ACCORD ACCORD study Group. N Engl J Med 2020. JORGE CE, et al. Diabetes Care, 2020. Byron J. Cleveland Clinic Journal of Medicine. 2020 The Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial ? 強(qiáng)化降糖治療 : 糖化血紅蛋白 A1c 目標(biāo)值低于 %. ? 標(biāo)準(zhǔn)降糖治療 : 糖化血紅蛋白 A1c 目標(biāo)值 % to %. 一級(jí)結(jié)果（非致命性心梗、卒中、心血管死亡）總發(fā)生率比較：強(qiáng)化治療組低于標(biāo)準(zhǔn)治療組， 主要?dú)w因于強(qiáng)化治療組非致命性心梗發(fā)生率明顯低于標(biāo)準(zhǔn)治療組 （ % vs. %, HR , 95% CI –, P=） 全因死亡率強(qiáng)化治療組高于標(biāo)準(zhǔn)治療組 22%（ P=），從而終止該試驗(yàn) 高血壓相關(guān)殘余風(fēng)險(xiǎn) ACCORD血壓試驗(yàn) Effects of Intensive Blood Pressure Control in the Management of Patients With Type 2 Diabetes Mellitus in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial ACCORD Study Group. N Engl J Med March 14, 2020. Giuseppe Mancia. Circulation. 2020. JOSHUA ,et Care, 2020 ? 治療 1年后平均收縮壓比較：標(biāo)準(zhǔn)治療 強(qiáng)化治療 ， δ= 強(qiáng)化治療降低收縮壓優(yōu)于標(biāo)準(zhǔn)治療 ACCORD Study Group. N Engl J Med March 14, 2020. 平均 SBP: 標(biāo)準(zhǔn)治療組 ；強(qiáng)化治療組 Comparison of CVD outes by level of central obesity in the ACCORD Blood Pressure Trial. 強(qiáng)化降壓降低卒中發(fā)生率，其余事件發(fā)生率組間無差異 強(qiáng)化治療嚴(yán)重不良事件發(fā)生率顯著增高 冠脈狹窄程度與心血管病事件殘余風(fēng)險(xiǎn) COURAGE study . John Mancini,et al. Circ Cardiovasc Interv. 2020 ? Angiographic Disease Progression and Residual Risk of Cardiovascular Events While on Optimal Medical Therapy Observations From the COURAGE (Clinical Outes Utilizin
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