Comprehensive Risk Factor Control Reduced Morbidity and Mortality in Diabetics全面控制危险因素降低糖尿病患者发病率和死亡率

A nonrandomized analysis of a randomized clinical trial concluded that simultaneous control of multiple risk factors (RFs) through protocol-guided intensive medical therapy is feasible and relates to cardiovascular morbidity and mortality in patients with ischemic heart disease and type 2 diabetes. In 2,265 patients (mean age 62 years, 29% women) followed up for 5 years, the number of RFs in control during the trial was strongly related to death and the composite of death, myocardial infarction, and stroke in fully adjusted models. Participants with 0 to 2 RFs in control during follow-up had a 2-fold higher risk of death and a 1.7-fold higher risk of the composite, compared with those with 6 RFs in control. The 6 RF goals are no smoking, non–high-density lipoprotein cholesterol 对一项随机临床试验的非随机分析得出的结论是，通过有计划的引导强化药物治疗，同时控制多种危险因素是可行的，且与缺血性心脏病和2型糖尿病患者心血管病的发病率和死亡率相关。对2265例患者（平均年龄62岁，29％为女性）随访了5年，经充分校正，试验期间受控危险因素的数量与死亡及死亡，心肌梗死和卒中的综合指标密切相关。与那些有6项危险因素受控者比较，仅有0-2项危险因素受控者随访期间死亡的风险高2倍，综合指标的风险高1.7倍。 6项危险因素的目标是不吸烟，非高密度脂蛋白胆固醇<130毫克/分升，甘油三酯<150毫克/分升，血压<130/80毫米汞柱，和糖化血红蛋白<7％。该分析还显示，总体而言，心肌血运重建术与最佳药物治疗之间死亡率或心血管事件没有差异，主张所有病情稳定的缺血性心脏病患者应该接受最佳药物治疗。对同一临床试验中2285例患者的另一项随机分析表明，肌钙蛋白T浓度成为2型糖尿病和稳定型缺血性心脏病患者一个强有力且独立的预后指标。来源：http://content.onlinejacc.org/; http://www.nejm.org/