-全面干预,终点受益-中国糖尿病患者风险管理1-精选（公开课件）.ppt

糖尿病：日益严重的全球危机 糖尿病患者心血管事件发病率显著增高 糖尿病患者的血栓性疾病危害—心肌梗死死亡率增高 糖尿病使冠心病死亡加速 糖耐量异常是心血管危险因素 HbAc1预测卒中风险 糖尿病是卒中的独立危险因素 10项临床研究结果分析 糖尿病卒中梗死体积变化更显著 英国80％糖尿病患者合并高血压 糖尿病增加高血压患者心血管死亡风险 糖尿病合并血脂异常者心血管疾病死亡率明显增加 糖尿病并发心血管疾病的机制-1 糖尿病并发心血管疾病的机制-2 预防糖尿病改变生活方式还是服用药物？ 行走一小步 = 获益一大步 减轻体重对糖尿病6年发生率的影响 戒烟对糖尿病患者健康的好处 UKPDS研究30年随访结果 综合因素强化治疗降低终点事件发生 糖尿病患者调脂治疗的收益 抗血小板治疗 抗栓治疗---阿司匹林提高糖尿病患者生存率 内科医师健康研究糖尿病患者首次心肌梗死危险降低61% 阿司匹林使高血压人群获益 AACE2008糖尿病前期管理指南推荐使用阿司匹林 实施生活方式干预，包括： 降低体重的5～10％ 每周5次不同强度的体育活动，每次30～60min 低脂高膳食纤维饮食 限盐限酒 如无禁忌症，需服用阿司匹林 将血压和血脂控制在糖尿病患者需要的范围内 理想与现实的差距 广州9家三甲医院内分泌科调查 总共991例2型糖尿病患者 平均年龄59.7±10.9岁 病程6.96±6.1年 Abstract PURPOSE: The benefit of aspirin treatment among diabetic patients with chronic coronary artery disease is not well established. The purpose of this study was to assess the effect of aspirin on cardiac and total mortality in a large cohort of diabetic patients with established coronary artery disease and to compare it with the effect of aspirin in nondiabetic counterparts. PATIENTS AND METHODS: In this observational study among patients screened for participation in the Bezafibrate Infarction Prevention Study, the effects of aspirin treatment in 2,368 non-insulin-dependent diabetic patients with coronary artery disease were compared to those in 8,586 nondiabetic patients. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated with proportional hazards models. RESULTS: Fifty-two percent of diabetic patients and 56% of nondiabetic patients reported aspirin therapy. After 5.1 ± 1.3 (mean ± SD) years of follow-up, the absolute benefit per 100 patients treated with aspirin was greater in diabetic patients than in nondiabetic patients (cardiac mortality benefit: 5.0 versus 2.1, and all-cause mortality benefit: 7.8 versus 4.1). Overall cardiac mortality among diabetic patients treated with aspirin was 10.9% versus 15.9% in the nonaspirin group (P 0.001), and all-cause mortality was 18.4% and 26.2% (P 0.001). After adjustment for possible confounders, treatment