1、混合型血脂异常与糖尿病他汀治疗关注糖尿病患者LDL-C,HDL-C和TG的全面控制工人医院 俞芳亚洲各国面临2型糖尿病的巨大挑战(2003-2025)0 10000 20000 30000 40000 50000 60000 70000 80000AustraliaChinaIndonesiaJapanKoreaMalaysiaPhilippinesSingaporeTaiwanThailandIndia20252003Number of People with Diabetes (000)Source: http:/www.eatlas.idf.org/prevalence/index (a
2、ccessed 10/7/2005)2型糖尿病:多重危险因素群聚的状态脂代谢紊乱胰岛素分泌缺陷大血管并发症中心性肥胖胰岛素抵抗微血管并发症高血压2型糖尿病糖尿病显著增加心血管疾病风险Bell DSH. Diabetes Care. 2003;26:2433-41.Centers for Disease Control (CDC). www.cdc.gov.2型糖尿病的心血管并发症65%的患者死于CV冠心病死亡2-4倍 中风2-4倍心衰 2-5倍内 容2型糖尿病混合型血脂异常与心血管预后2型糖尿病混合型血脂异常他汀干预的终点 证据胰岛素抵抗和糖尿病增加小而致密LDL颗粒的数量0102030405
3、060708090100IS IR Type 2 DMLDL = low-density lipoprotein; SD = standard deviation; IS = insulin-sensitive; IR = insulin resistance.Garvey WT, et al. Diabetes. 2003;52:453-462.Concentration of Small DenseLDL, mg/dL(mean SD)糖尿病患者混合型血脂异常与心血管危险显著相关TG水平上升LDL-C在平均水平至中度上升低水平HDL-C小而密的颗粒UKPDS心血管危险因素回归分析 CHD危
4、险LDL-C 1 mmol/L 57HDL-C 0.1 mmol/L 15SBP 10 mmHg 15HbA1c1% 11“Triglyceride concentration was a risk factor for coronary artery disease after adjustment for age and sex, but it was not an independent risk factor when the other variables were included in the model.”Turner RC et al BMJ 1998;316:823-828
5、.Lancet 2008; 371: 117-25 对CTT(Meta)现有14 加上 他汀的2 性 (4D,ASPEN) 合分析 低1mmol/L LDL-C 血管 20 ，与原来结果类似 常 量他汀对糖尿病患者的冠心病 预 有显著疗 他汀 他汀 糖尿病合并冠心病患者的currency1“Ballantyne CM. Circulation. 2001;104:3046-3051.Lipid Triad Group: Baseline: LDL-C=195mg/dL, TG=191mg/dL, HDL-C=33mg/dL;Lipid Triad Group: n=424; Sim: n=20
6、6; Placebo: n=218. 35.7% simvastatin patients were titrated from 20 to 40mg at 1 year. 他汀显著糖尿病合并冠心病患者血脂异常fi症 4S 他汀 低糖尿病合并冠心病fl血脂异常fi症患者的心血管 风险 4S (LDL+ Low HDL+ High TG)LDL=low-density lipoprotein; HDL=high-density lipoprotein; TG=triglycerides.CVEventRate(%)CVEventRate(%)4037.524.235.5血脂异常fi症 糖尿病血脂异常fi症 糖尿病血脂异常fi症 糖尿病血脂异常fi症 糖尿病33 197 188 192 218 1794 1782n18.137.523.425.919.001020304050 他汀Ballantyne CM. Circulation. 2001;140:3046-3051
