胰岛素抵抗糖尿病与冠心病英文课件.ppt

1、Adapted from World Health Organization.Definition,Diagnosis and Classification of Diabetes Mellitus and its Complications.Geneva:World Health Organization:1999:52.7.0(126)6.1(110)to 7.0(11.1(200)7.8(140)to11.1(200)Values are mmol/L(mg/dl)0123456789DevelopedDevelopingPercentKing H et al.Diabetes Care

2、 1998;21:1414-1431.World199520002025American Diabetes Association.Economic Consequences of Diabetes Mellitusin the US in 1997.Alexandria,VA:American Diabetes Association,1998:1-14.n Total costs 12 billion US$n CVD accounts for 64%of total costsOthersOphthalmic diseaseCardiovasculardiseaseRenal disea

3、seNeurologic diseasePeripheral vascular disease024681012141618Annual CHD Deaths per 1000 PersonsKannel WB,McGee DL.JAMA 1979;241:2035-2038.01020304050Ischemicheartdisease%of DeathsGeiss LS et al.In:Diabetes in America.2nd ed.1995;chap 11.OtherheartdiseaseDiabetes CancerStroke InfectionOther051015202

4、53035Mortality per 1000 person-years*Age-adjustedAdapted from Gu K et al.Diabetes Care 1998;21:1138-1145.29.919.2MenWomenAll heart diseaseIschemic heart diseaseMenWomen11.56.323.07.111.03.605101520 *Defined in 1971-1975,followed up through 1982-1984.*Defined in 1982-1984,followed up through 1992-199

5、3.Gu K et al.JAMA 1999;281:1291-1297.17.06.814.27.67.44.22.41.9(P=0.46)(P=0.76)(P200 mg/dl,smoking,SBP 120 mmHgStamler J et al.Diabetes Care 1993;16:434-444All threeNo diabetesDiabetesTwo onlyBLACK BOXn Dyslipidemian Hypertensionn Hyperinsulinemia/insulin resistancen Hemostatic abnormalitiesn Hyperg

6、lycemian AGE proteinsn Oxidative stressAGE=advanced glycation end productsAdapted from Bierman EL.Arterioscler Thromb 1992;12:647-656.+=moderately increased compared with nondiabetic population+=markedly increased compared with nondiabetic population =not different compared with nondiabetic populati

7、onDyslipidemia Hypertriglyceridemia Low HDL Small,dense LDL Increased apo BHypertensionHyperinsulinemia/insulin resistanceCentral obesityFamily history of atherosclerosisCigarette smokingAdapted from Chait A,Bierman EL.In:Joslins Diabetes Mellitus.Philadelphia:Lea&Febiger,1994:648-664.+Howard BV et

8、al.Diabetes Care 1998;21:1258-1265.0-2-4-6-8Differences between participants with and without diabetes0-2-4-6-8mg/dLn Microvascular complications-Aggressive screening-Improved metabolic controln Macrovascular complications-Improved glycemic control(positive but minor)-Prevention of type 2 diabetes-A

9、ggressive treatment of established CVRF in diabetic and possibly prediabetic subjects-Diabetic agents that improve cardiovascular risk01020304050110120130140150160170Incidence per 1000 Person Years(%)Adler AI et al.BMJ 2000;321:412-419.Updated Mean Systolic Blood Pressure(mmHg)Adjusted for age,sex,a

10、nd ethnic groupMyocardial InfarctionMicrovascular Endpoints020406080567891011Incidence per 1000 Person Years(%)Stratton IM et al.BMJ 2000;321:405-412.Updated Mean Hemoglobin A1c Concentration(%)Adjusted for age,sex,and ethnic groupMyocardial InfarctionMicrovascular EndpointsDespres JP et al.N Engl J

11、 Med 1996;334:952-957.0.02.04.06.08.0Odds Ratio15F-Insulin(U/ml)4.6p=0.005150 mg/dl150 mg/dlTriglycerides1.01.55.3p=0.001P0.0016.75.4P=0.002Despres JP et al.N Engl J Med 1996;334:952-957.0.02.04.06.08.010.012.0Odds Ratio15F-Insulin(U/ml)3.0p=0.04119 mg/dl119 mg/dlApolipoprotein B1.01.53.2p0.00111.09

12、.7P25.6425.64LDL Peak Particle Diameter(nm)1.01.06.2(p120 mg/dl2.0120 mg/dlBMI(kg/m2)Centrality*TG(mmol)HDLC(mmol)SBP(mmHg)Fasting glucose(mmol)Fasting insulin(pmol)Haffner SM et al.JAMA 1990;263:2893-2898.28.2+1.11.38+0.091.83+0.121.14+0.07116.8+3.05.28+0.1157+2727.2+0.21.16+0.21.26+0.101.28+0.0210

13、8.8+0.85.00+0.0281+5.472.472.006.045.004.032.006Conversion Status at Follow-up*Ratio of subscapular to triceps skinfoldsWHO.Diabetologia 1985;28:615-640;Haffner SM et al.JAMA 1990;263:2893-2898.Lehto S et al.Diabetes 1997;46:1354-1359.403020100%IncidenceP-glucose(mmol/L)13.4403020100%IncidenceCHD Mo

14、rtalityAll CHD EventsCHD MortalityAll CHD EventsHbA1(%)10.7 Low-Density Lipoprotein CholesterolHigh-Density Lipoprotein CholesterolHemoglobin A1cSystolic Blood PressureSmoking0.0001 0.0001 0.0022 0.00650.056Coronary Artery Disease(n=280)FirstSecondThirdFourthFifth*Adjusted for age and sex.Turner RC

15、et al.BMJ 1998;316:823-828.n The risk of vascular disease is similar in diabetic subjects without pre-existing vascular disease as in nondiabetic subjects with vascular diseasen Glycemia alone will not completely eliminate the excess of CHD risk in diabetic subjectsn Lipid interventions to reduce CH

16、D can be equally effective in diabetic and nondiabetic subjects01020304050Incidence During Follow-up(%)(n=69)Nondiabetics with prior MINondiabetics with no prior MIDiabetics with prior MIDiabetics with no prior MI18.8Haffner SM et al.N Engl J Med 1998;339:229-234.(n=1304)(n=169)(n=890)3.00.57.83.23.

17、545.020.2Events per100 person-yr:P0.001p0.0010510152025Incidence During Follow-up(%)(n=69)Nondiabetics with prior MINondiabetics with no prior MIDiabetics with prior MIDiabetics with no prior MI7.2Haffner SM et al.N Engl J Med 1998;339:229-234.(n=1304)(n=169)(n=890)1.20.33.41.61.919.510.3Events per1

18、00 person-yr:P=0.01p0.001Epidemiological data suggest that the risk of CHD in type 2 diabetes is equivalent to that in people with prevalent CHD.Although hyperglycemia is significantly related to CHD,the magnitude of association is unlikely to explain the entire excess risk of cardiovascular disease.Within type 2 diabetics,increased blood pressure and LDL-C and low HDL-C also predict the risk of future myocardial infarction.