血脂异常与糖尿病他汀治疗策略.pptVIP

* 中国7大城市共52所三级医院3513例冠心病患者调查显示冠心病合并有糖尿病异常的患者占冠心病患者52.9% 冠心病:慢性稳定型心绞痛,急性冠脉综合征和陈旧性心肌梗死. 糖代谢状况:对过去已确定诊断糖尿病的患者收集空腹血糖( FPG) 、餐后或随机血糖资料. 未确诊糖尿病的患者均接受口服葡萄糖耐量试验(OGTT) ,急性冠心病患者需在出院前3 ～4 天进行OGTT试验,慢性患者无试验日期的限制; OGTT仅检测FPG和糖负荷后2h血糖( 2hPG)两个点,且OGTT试验只做一次; 全体研究对象中,入院后通过非OGTT方法诊断的糖尿病为97例, OGTT诊断为糖尿病及IGR分别为609和844例,说明全体研究对象入院前有706例合并糖尿病患者未被诊断, 占全部糖尿病患者的38. 0%; IGR的糖尿病前期患者几乎全部被漏诊; 即入院前全部糖代谢异常的患者(包括糖尿病和IGR)中有57. 3% (1 550 / 2 703)被漏诊。 糖尿病包括单纯性空腹高血糖( IFH, FPG≥7. 0 mmol/L且2hPG 11. 1 mmol/L ) 、单纯性负荷后高血糖( IPH, FPG 7. 0 mmol/L且2hPG≥11. 1 mmol/L) 、复合性高血糖(CH, FPG≥7. 0 mmol/L 且2hPG≥11. 1mmol/L) 目前,国内大部分机构在进行心血管专科疾病的临床实践中,主要采用FPG检测,OGTT试验的普及率尚不足。研究结果提示,若不进行OGTT试验,单纯的FPG检测将有80. 5%的糖尿病患者被漏诊和87. 4%的IGT患者被漏. * 糖尿病显著降低CABG围手术期和长期存活率, 升高PCI患者再狭窄与重复血运重建需要, 降低PCI患者长期存活率 * 与糖尿病相关的心血管危险因子很多，与血脂相关的有LDL颗粒小而密;低的HDL-C，高TG等。 Insulin resistance, the resulting hyperinsulinemia, and CAD have complex associations. What may be clearly seen here, however, is that many of the cardiovascular risk factors that characterize metabolic syndrome are associated with insulin resistance. Increased fasting insulin levels as well as increased fasting glucose levels predict arterial stiffness, which in turn promotes hypertension, another known risk factor for CVD. Abnormal lipid levels characterized by low HDL-C, the presence of small, dense LDL particles, and elevated triglycerides are promoted by insensitivity to insulin, as normal lipoprotein metabolism becomes dysfunctional. Other consequences include hypercoagulation and impaired fibrinolysis. Enhanced lipid breakdown from insulin-resistant adipose cells results in increased availability of free fatty acids, and ultimately increased deposition of lipid in the arterial wall. This in turn leads to increases in vascular inflammation and the production of inflammatory markers. McFarlane SI, Banerji M, Sowers JR. Insulin resistance and cardiovascular disease. J Clin Endocrinol Metab. 2001;86:713-718. Reusch JEB. Current concepts in insulin resistance, type 2 d