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【正文】 % (p=.002) LIPID Pravastatin 782 25% 19% 4S Reanalysis Simvastatin 483 32% 42% (p=.001) HPS Simvastatin 1981 24% 15% CHD Prevention Trials with Statins in Diabetic Subjects: Subgroup Analyses Downs JR et al. JAMA 1998。279:16151622. | HPS Collaborative Group. Lancet 2021。361:20212021. | Goldberg RB et al. Circulation 1998。98:25132519. | Py246。r228。l228。 K et al. Diabetes Care 1997。20:614620. | LIPID Study Group. N Engl J Med 1998。339:13491357. | Haffner SM et al. Arch Intern Med 1999。159:26612667. Completed Clinical Trials with Antihypertensive Agents in Diabetes Trial Diabetic/Total Results SHEP 583/4736 Beneficial GISSI3 2790/18,131 Beneficial SystEur 492/4695 Beneficial HOT 1501/18,790 Beneficial UKPDS 1148 Beneficial CAPPP 572/10,985 Beneficial Curb JD et al. JAMA 1996。276:18861892. | Zuati G et al. Circulation 1997。96:42394245. | Staessen JA et al. Am J Cardiol 1998。82:20R–22R. | Hansson L et al. Lancet 1998。351:17551762. | UKPDS Group. BMJ 1998。317:703713. | Hansson L et al. Lancet 1999。353:611616. Isolated ? LDLC RR= (–) 010203040221 “ Metabolic Syndrome” in 4S Event Rate, % Ballantyne CM et al. Circulation 2021。104:30463051. Simvastatin Placebo 237 261 284 Lipid Triad RR= (–) 01020304050607080Glycosylated hemoglobin % Efficacy of Multiple Risk Factor Intervention in HighRisk Subjects (Type 2 Diabetes with Microalbuminuria): Steno2 Patients Reaching IntensiveTreatment Goals at Mean 7.8 y, (%) G230。de P et al. N Engl J Med 2021。348:383393. Intensive Therapy Cholesterol 175 mg/dl Triglycerides 150 mg/dl Systolic BP 130 mm Hg Diastolic BP 80 mm Hg Conventional Therapy P= P P= P= P= Copyright 169。 2021 Massachusetts Medical Society. All rights reserved. 0102030405060Composite Endpoint of Death from CV Causes, Nonfatal MI, CABG, PCI, Nonfatal Stroke, Amputation, or Surgery for PAD: STENO2 Primary Composite Endpoint (%) Months of Followup G230。de P et al. N Engl J Med 2021。348:383393. 0 24 48 60 96 36 84 72 12 Conventional Therapy Intensive Therapy P= Hazard ratio = (95% CI, –。 P=) Copyright 169。 2021 Massachusetts Medical Society. All rights reserved. Summary: Metabolic Syndrome ? The metabolic syndrome predicts the development of both diabetes and CHD ? Insulin resistance and obesity characterize most individuals subjects with the metabolic syndrome, although not required features of the NCEP metabolic syndrome ? Initial therapy for the metabolic syndrome should consist of caloric restriction and increased physical activity ? Conventional cardiovascular risk factors such as lipids and blood pressure should be treated in individuals with the metabolic syndrome, although no remendations have so far suggested intensification of risk factor management ? No consensus exists on whether insulin sensitizers should be used in nondiabetic individuals with the metabolic syndrome
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