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 <130 mg/dl, triglycerides <150 mg/dl, blood pressure <130/80 mm Hg, and glycosylated hemoglobin <7%. The analysis also showed no overall difference for mortality or cardiovascular events between revascularization and optimal medical therapy and argued for that all patients with stable ischemic heart disease should receive optimal medical therapy. Another randomized analysis of the same trial in 2285 patients revealed that troponin T concentration was a powerful independent prognostic marker in patients with type 2 diabetes and stable ischemic heart disease. Source: http://content.onlinejacc.org/; http://www.nejm.org/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/
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