控制糖尿病患者心血管危险的干预治疗策略.ppt
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1、控制糖尿病患者心血管危险 的干预治疗策略,糖尿病与心血管危险 影响心血管危险的因素 综合控制的理论与实践,Countries With Highest Numbers of Estimated Cases of Diabetes for 2000 and 2030,Ranking,Country,People with diabetes (millions),Country,People with diabetes (millions),2000,2030,1 India 31.7 India 79.4 2 China 20.8 China 42.3 3 U.S. 17.7 U.S. 30.3
2、 4 Indonesia 8.4 Indonesia 21.3 5 Japan 6.8 Pakistan 13.9 6 Pakistan 5.2 Brazil 11.3 7 Russian Federation 4.6 Bangladesh 11.1 8 Brazil 4.6 Japan 8.9 9 Italy 4.3 Pinecones 7.8 10 Bangladesh 3.2 Egypt1 6.7,Total: 177 million,366 MILLION BY 2030,Type 2 diabetes and CHD 7-Year Incidence of Fatal/Nonfata
3、l MI (East West Study),Incidence During Follow-up (%),(n=69),Nondiabetics with prior MI Nondiabetics with no prior MI Diabetics with prior MI Diabetics with no prior MI,18.8,Haffner SM et al. N Engl J Med 1998;339:229-234.,(n=1304),(n=169),(n=890),3.0,0.5,7.8,3.2,3.5,45.0,20.2,Events per 100 person-
4、yr:,P0.001,p0.001,Type 2 diabetes and Stroke 7-Year Incidence of Fatal/Nonfatal Stroke (East West Study),Incidence During Follow-up (%),(n=69),Nondiabetics with prior MI Nondiabetics with no prior MI Diabetics with prior MI Diabetics with no prior MI,7.2,Haffner SM et al. N Engl J Med 1998;339:229-2
5、34.,(n=1304),(n=169),(n=890),1.2,0.3,3.4,1.6,1.9,19.5,10.3,Events per 100 person-yr:,P=0.01,p0.001,Prevalence of CHD by the Metabolic Syndrome and Diabetes in the NHANES Population Age 50+,Alexander C et al. Diabetes 2003;52:1210-1214,25%,20%,15%,10%,5%,0%,No MS/No DM,8.7%,13.9%,7.5%,19.2%,MS/No DM,
6、DM/No MS,DM/MS,% of population = 54.2% 28.7% 2.3% 14.8%,CHD Prevalence,Schillaci G. JACC. 2004; 43:1817-1822,代谢综合征与心血管危险,Ml and Microvascular End Points: Incidence by Mean Systolic BP and HbA1c Concentration,Ml,Microvascular and points,Ml,Microvascular and points,50,40,30,20,10,0,80,60,40,20,0,Adjus
7、ted incidence per 1000 person-yr (%),110,120,130,140,150,160,170,5,6,7,8,9,10,11,Updated mean systolic BP (mmHg),Updated mean HbA1c concentration (%),Adjusted incidence per 1000 person-yr (%),Adler Al et al. BMJ 2000;321:412-419,Stration IM et al. BMJ 2000;321:405-412,MetS和DM患者血脂异常特征,游离脂肪酸 TG HDL-C
8、VLDL-C 小而密LDL颗粒 氧化LDL-C 餐后高脂血症,Male,Gender-adjusted,Female,Reduced risk with small, dense LDL,0.1,Relative risk for myocardial infarction,1,10,Increased risk with small, dense LDL,Small, dense LDL increases cardiovascular risk,UKPDS Stepwise Selection of Risk Factors* in Patients with Type 2 Diabete
9、s,Variable LDL-C HDL-C Hemoglobin A1c Systolic Blood Pressure Smoking,P Value 0.0001 0.0001 0.0022 0.0065 0.056,Coronary Artery Disease (n=280),Position in Model First Second Third Fourth Fifth,*Adjusted for age and sex. Turner RC et al. BMJ 1998;316:823-828.,Mangaging overweight in type 2 diabetics
10、,Effective weight management is the first step in treating type 2 diabetes,Weight loss (kg) in first 12 months,Lean MEJ et al., Diabet Med, 1990;7:228-233,Weight loss is difficult to maintain by diet and exercise alone in type 2 diabetes,UKPDS 34. Lancet 1998;352:354,Insulin,Chlorpropamide,Gllbencla
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- 关 键 词:
- 控制 糖尿病患者 心血管 危险 干预 治疗 策略
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