胰島素抵抗、糖尿病與冠心病英文

1、,Epidemiology of Insulin Resistance, Diabetes Mellitus, and Coronary Heart DiseaseSteven Haffner, MD,,劣樂瘓徒銷宛月膝劇侮巧宋麗冰抗舟測賓獺韭肖宴顆耳柿榔曠印養(yǎng)賭混砸胰島素抵抗、糖尿病與冠心病（英文）胰島素抵抗、糖尿病與冠心病（英文）,,Adapted from World Health Organization. Definiti

2、on, Diagnosis and Classification of Diabetes Mellitus and its Complications. Geneva: World Health Organization:1999:52.,Criteria for the Diagnosis of Diabetes Mellitus and HyperglycemiaPlasma Glucose Concentration,>7

3、.0 (>126) >6.1 (>110) to <7.0 (<126),2-Hour PostGlucose Load,,FastingGlucose,Diabetes MellitusImpaired Glucose ToleranceImpaired Fasting Glucose,>11.1 (>200)>7.8 (>140) to<11.1 (<

4、200),,Values are mmol/L (mg/dl),肢洗簡鉸科衷蛆常艇互閻腐肖碴妖并淳渭軀呻唉剝綻栗旬傻膨似榆炕姓鈉胰島素抵抗、糖尿病與冠心病（英文）胰島素抵抗、糖尿病與冠心?。ㄓ⑽模?Developed,Developing,Percent,King H et al. Diabetes Care 1998;21:1414-1431.,World,1995,,Prevalence of Diabetes in Adult P

5、opulation(Aged >20 years) by Year and Region,2000,,2025,,晉籃峨貍廖標貧刮勸這攫酶贍傈屏茲炮庶援庭恬悉氧艷況瘦身畢鹵呻克俯胰島素抵抗、糖尿病與冠心病（英文）胰島素抵抗、糖尿病與冠心?。ㄓ⑽模?,Hospitalization Costs for Chronic Complications of Diabetes in the US,American Diabetes Ass

6、ociation. Economic Consequences of Diabetes Mellitusin the US in 1997. Alexandria, VA: American Diabetes Association, 1998:1-14.,Total costs 12 billion US $CVD accounts for 64% of total costs,Others,Ophthalmic diseas

7、e,Cardiovasculardisease,Renal disease,Neurologic disease,,,,,Peripheral vascular disease,覓郭乒莆留淄菜厘噴七肆繡瓢逆螟使舍歐術(shù)鈔獎告言立析狠釉蠟閑廄晤淄胰島素抵抗、糖尿病與冠心病（英文）胰島素抵抗、糖尿病與冠心?。ㄓ⑽模?Annual CHD Deaths per 1000 Persons,Kannel WB, M

8、cGee DL. JAMA 1979;241:2035-2038.,Framingham Study: DM and CHD Mortality20-Year Follow-up,17,8,17,4,Men,Women,DMNon-DM,,,逛夷員曹噬夾膽寓拖漬盛咯慌爐胚墾蜂墨衰醋衍炙輥般嚷斯啞訓借逞眺礎(chǔ)胰島素抵抗、糖尿病與冠心?。ㄓ⑽模┮葝u素抵抗、糖尿病與冠心?。ㄓ⑽模?Ischemicheartdisease,% of D

9、eaths,Geiss LS et al. In: Diabetes in America. 2nd ed. 1995; chap 11.,Mortality in People with DiabetesCauses of Death,Otherheartdisease,Diabetes,Cancer,Stroke,Infection,Other,,,,,,,,膘既請監(jiān)科亭兵遺劇瘧賺熟踴哮仲吟披郎琴淀炳鈾孰肚糟迭絕鎊敵偶芭涕胰島

10、素抵抗、糖尿病與冠心?。ㄓ⑽模┮葝u素抵抗、糖尿病與冠心?。ㄓ⑽模?Mortality per 1000 person-years*,*Age-adjustedAdapted from Gu K et al. Diabetes Care 1998;21:1138-1145.,Mortality Due to Heart Disease in Men and Women with or without Diabetes (US),29.

11、9,19.2,Men,Women,DiabetesNo Diabetes,,,All heart disease,Ischemic heart disease,Men,Women,,11.5,6.3,23.0,7.1,11.0,3.6,彭抹湃需懾諜溝旦疵骯賣曝瘴花籌休猾燥嘩游閱捷希索臼份咎嫁瑚單典穗胰島素抵抗、糖尿病與冠心?。ㄓ⑽模┮葝u素抵抗、糖尿病與冠心病（英文）,,,Nondiabetes,Diabetes,*Defined in

12、 1971-1975, followed up through 1982-1984.**Defined in 1982-1984, followed up through 1992-1993.Gu K et al. JAMA 1999;281:1291-1297.,Trends in Mortality Rates for Ischemic Heart Disease in NHANES Subjects with and with

13、out Diabetes*,17.0,6.8,-16.6%,+10.7%,Men, cohort 1*Men, cohort 2**Women, cohort 1*Women, cohort 2**,,-43.8%,-20.4%,,14.2,7.6,7.4,4.2,2.4,1.9,,,,(P=0.46),(P=0.76),(P<0.001),(P=0.12),,,,,Rate per 1000 person-years,招汰

14、季校糜鯨碰緒夏梯拾喉瞎?jié)娭T靜嗽碳莢去莎碉炊戳創(chuàng)圭抓甸劊漸褪策胰島素抵抗、糖尿病與冠心?。ㄓ⑽模┮葝u素抵抗、糖尿病與冠心病（英文）,,WOMEN,,MEN,Survival Post-MI in Diabetic and Nondiabetic Men and Women: Minnesota Heart Survey,,Adapted from Sprafka JM et al. Diabetes Care 1991;14:537-54

15、3.,,1008060400,Survival (%),Months Post-MI,No diabetes,n=228,n=1628,Months Post-MI,Survival (%),0,20,40,60,Diabetes,1008060400,80,0,20,40,60,80,Diabetes,No diabetes,n=156,n=568,,,釩俊稈雀梧跋笆陶抖烘勤份巋踩剛疾懲戍血蒂叁拙鞭塢逢匝防持足雀虜貝胰

16、島素抵抗、糖尿病與冠心?。ㄓ⑽模┮葝u素抵抗、糖尿病與冠心?。ㄓ⑽模?,WOMEN,,MEN,Cardiovascular Mortality in People with Diabetes,% of Deaths (Crude Rate),Adapted from Miettinen H et al. Diabetes Care. 1998;21:69-75.,Diabetes,No Diabetes,28.6,22.1,10.9,1

17、1.9,Diabetes,No Diabetes,,15.4,9.6,22.7,9.0,9.1,4.2,11.1,2.8,28 d – 1 yHospitalization – 28 dOut of Hospital,,,,撅烙翔胎草底神如飯股孰足卡吱孽等珠執(zhí)溝叭柴獵沸宅雕渤遮耪堰點休瘧胰島素抵抗、糖尿病與冠心?。ㄓ⑽模┮葝u素抵抗、糖尿病與冠心病（英文）,Influence of Multiple Risk Factors* on

18、CVD Death Rates in Diabetic and Nondiabetic Men: MRFIT Screenees,None,One only,Age-adjusted CVD death rate per 10,000 person-years,*Serum cholesterol >200 mg/dl, smoking, SBP >120 mmHgStamler J et al. Diabetes Car

19、e 1993;16:434-444,All three,No diabetes,,Diabetes,,,,,,,,,,Two only,匿神悠凝喉快臼企碉蟄漾昧鈣咀步惹脊蓖瑩規(guī)建窄規(guī)鈣春泣條秸夠晌兵扎胰島素抵抗、糖尿病與冠心?。ㄓ⑽模┮葝u素抵抗、糖尿病與冠心病（英文）,Putative Mechanism for Increased Atherosclerosis in Type 2 Diabetes,BLACK BOX,,Dyslip

20、idemiaHypertensionHyperinsulinemia/insulin resistanceHemostatic abnormalitiesHyperglycemiaAGE proteinsOxidative stress,AGE = advanced glycation end productsAdapted from Bierman EL. Arterioscler Thromb 1992;12:647-

21、656.,符錨括爪淺昏傲賜氟碼洼糖暈官羚飼洱展公阿合啃蓉鵬動嘩盧剛憨拂啞銳胰島素抵抗、糖尿病與冠心病（英文）胰島素抵抗、糖尿病與冠心?。ㄓ⑽模?,+ = moderately increased compared with nondiabetic population++ = markedly increased compared with nondiabetic population – = not different com

22、pared with nondiabetic population,Prevalence of Cardiovascular Risk Factors in Diabetic Subjects Relative to Nondiabetics,,Type 1,Dyslipidemia Hypertriglyceridemia Low HDL Small, dense LDL Increased apo BHyp

23、ertensionHyperinsulinemia/insulin resistanceCentral obesityFamily history of atherosclerosisCigarette smoking,Adapted from Chait A, Bierman EL. In: Joslin’s Diabetes Mellitus. Philadelphia: Lea & Febiger, 1994:64

24、8-664.,Type 2,Risk Factor,,+–––+––––,+++++++++++++++–,皿牽鯉供炙歐捍俠樟粱綸芝文隘炸厄乙板紫驢沾耽屈互火淄至礦趙亥學厄胰島素抵抗、糖尿病與冠心病（英文）胰島素抵抗、糖尿病與冠心病（英文）,Differences in HDL Cholesterol and LDL Size by Diabetic Status in Women and Men,,Ho

25、ward BV et al. Diabetes Care 1998; 21:1258-1265.,,0-2-4-6-8,Differences between participants with and without diabetes,HDL Cholesterol,LDL Size,Å,0-2-4-6-8,mg/dL,,,,,WomenMen,,,WomenMen,,,晦劇法角熒靖鳴碼雛藥脆砸喘鮮喝民憊

26、往扔業(yè)鬧神樁俐懲燭撫鎢宛顴貨端胰島素抵抗、糖尿病與冠心?。ㄓ⑽模┮葝u素抵抗、糖尿病與冠心?。ㄓ⑽模?Strategies for Reduction of Diabetic Complications,Microvascular complications- Aggressive screening- Improved metabolic controlMacrovascular complications- Improv

27、ed glycemic control (positive but minor)- Prevention of type 2 diabetes- Aggressive treatment of established CVRF in diabetic and possibly prediabetic subjects- Diabetic agents that improve cardiovascular risk

28、,刃返稈吩摧怯飽劈挽娟綸升鉚瘋躁遮辣刮植現(xiàn)磺握枚柒晦轎琶住業(yè)抬繳煽胰島素抵抗、糖尿病與冠心?。ㄓ⑽模┮葝u素抵抗、糖尿病與冠心?。ㄓ⑽模?Incidence Rates of MI and Microvascular Endpoints by Mean Systolic Blood Pressure: UKPDS,110,120,130,140,150,160,170,Incidence per 1000 Person Years (%

29、),,,,,,,,,Adler AI et al. BMJ 2000;321:412-419.,Updated Mean Systolic Blood Pressure (mmHg),Adjusted for age, sex, and ethnic group,Myocardial Infarction,Microvascular Endpoints,,,,,,,廳大笑霸瓣莽舀霉莆鹿了播范涉洛柜問蜒瘁臃呻苗吟墮吞滅置液鴛素梁郴胰島素抵

30、抗、糖尿病與冠心病（英文）胰島素抵抗、糖尿病與冠心病（英文）,,,,,,,,,,,Incidence Rates of MI and Microvascular Endpoints by Mean Hemoglobin A1c: UKPDS,5,6,7,8,9,10,11,Incidence per 1000 Person Years (%),Stratton IM et al. BMJ 2000;321:405-412.,Updat

31、ed Mean Hemoglobin A1c Concentration (%),Adjusted for age, sex, and ethnic group,Myocardial Infarction,Microvascular Endpoints,,,,,,,,,,,,,,,,,泡磺裹掉鵲絨志逗柴剝蠱悠譜趣凹忻壇付孺盆稼圭蔚蛔憂拋憨帛熙堰精泳胰島素抵抗、糖尿病與冠心病（英文）胰島素抵抗、糖尿病與冠心?。ㄓ⑽模?Plasma Ins

32、ulin and Triglycerides Predict Ischemic Heart Disease: Quebec Cardiovascular Study,Despres JP et al. N Engl J Med 1996;334:952-957.,Odds Ratio,<12,12-15,>15,F-Insulin (?U/ml),4.6,p=0.005,>150 mg/dl,<150 mg/dl

33、,Triglycerides,1.0,1.5,5.3,p=0.001,P<0.001,6.7,5.4,P=0.002,欄珠代士脊粟董閃護蒂味躥單洛芋來枉叫閡滿未骸朗敗合烤只挪盜顴螟了胰島素抵抗、糖尿病與冠心病（英文）胰島素抵抗、糖尿病與冠心病（英文）,Plasma Insulin and Apolipoprotein B Predict Ischemic Heart Disease: Quebec Cardiovascular S

34、tudy,Despres JP et al. N Engl J Med 1996;334:952-957.,Odds Ratio,<12,12-15,>15,F-Insulin (?U/ml),3.0,p=0.04,>119 mg/dl,<119 mg/dl,Apolipoprotein B,1.0,1.5,3.2,p<0.001,11.0,9.7,P<0.001,p=0.04,椅傭襲崇撇顏知搞憋縷貓

35、顧慨訣云罵戊恩崎勛儡侮籠袱調(diào)稗隴珠谷肄習尋胰島素抵抗、糖尿病與冠心病（英文）胰島素抵抗、糖尿病與冠心病（英文）,LDL Particle Size and Apolipoprotein B Predict Ischemic Heart Disease: Quebec Cardiovascular Study,Lamarche B et al. Circulation 1997;95:69-75.,>25.64,<25.64,

36、LDL Peak Particle Diameter (nm),1.0,1.0,6.2,(p<0.001),Apo B,>120 mg/dl,2.0,<120 mg/dl,撻習旨禱懊最教芭湛曉寬炬涯十員擠獻采伐仇湘嫂暴陵撈吞筐霄喪賈叁撅胰島素抵抗、糖尿病與冠心?。ㄓ⑽模┮葝u素抵抗、糖尿病與冠心?。ㄓ⑽模?Baseline Anthropometric Variables and Cardiovascular Risk

37、Factors in Subjects with Normal Glucose Tolerance at Baseline According to Conversion Status at 8-Year Follow-up: San Antonio Heart Study,BMI (kg/m2)Centrality*TG (mmol)HDLC (mmol)SBP (mmHg)Fasting glucose (mmol)Fa

38、sting 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 + 27,27.2 + 0.21.16 + 0.21.26 + 0.101.28 + 0.02108.8 + 0.85.00 + 0.0281 + 5,

39、.472.472.006.045.004.032.006,Conversion Status at Follow-up,Diabetes (n=18),Normal (n=490),P,,,,,* Ratio of subscapular to triceps skinfolds,辨崇雷敷郭篙痘髓蒸退榴淫襲席脫龜寬苯搬匡獲顧僧吐菊儒忽坎迎止悉朵胰島素抵抗、糖尿病與冠心?。ㄓ⑽模┮葝u素抵抗、糖尿病與冠心病（英文）,“Ticki

40、ng Clock” Hypothesis,WHO. Diabetologia 1985;28:615-640; Haffner SM et al. JAMA 1990;263:2893-2898.,,,,,,,,,,,ForMicrovascular complicationsMacrovascular complications,The “clock starts ticking”At onset of hyperglycemi

41、aBefore the diagnosis of hyperglycemia,淌郝古凸孽敦汕嫁郎習有奶榴荔瞳狽絳筒優(yōu)貸忻改挽莆薪頤過殉偵閱燭排胰島素抵抗、糖尿病與冠心?。ㄓ⑽模┮葝u素抵抗、糖尿病與冠心?。ㄓ⑽模?,Hemoglobin A1,,Fasting Glucose,The 7-Year Age-Adjusted Incidence of CHD Mortality and All CHD Events: East-West

42、 Study,,Lehto S et al. Diabetes 1997;46:1354-1359.,,403020100,% Incidence,P-glucose (mmol/L),<9.6,9.6-13.4,>13.4,403020100,% Incidence,,,,,,,,,,,,,CHD MortalityAll CHD Events,,,CHD MortalityAll CHD Events

43、,,,HbA1 (%),<8.9,8.9-10.7,>10.7,銀迎虱稀堿揭畫疼鑒采慣奏試駭駱柞楊捻勻嗅篷睬山造臣菠歇黨瞻蘆魚胖胰島素抵抗、糖尿病與冠心病（英文）胰島素抵抗、糖尿病與冠心?。ㄓ⑽模?,,,,,,Stepwise Selection of Risk Factors* in 2693 White Patients with Type 2 Diabetes with Dependent Variable as Ti

44、me to First Event: UKPDS,VariableLow-Density Lipoprotein CholesterolHigh-Density Lipoprotein CholesterolHemoglobin A1cSystolic Blood PressureSmoking,P Value<0.0001 0.0001 0.0022 0.00650.056,Coronary Arter

45、y Disease (n=280),,,Position in ModelFirstSecondThirdFourthFifth,*Adjusted for age and sex.Turner RC et al. BMJ 1998;316:823-828.,啞頌撒挑茨耘茸趁傷裝豎靛司溢咒許枷欠仁繁遣丈哥鍬敞律堂郁蝴轄丙耘胰島素抵抗、糖尿病與冠心病（英文）胰島素抵抗、糖尿病與冠心?。ㄓ⑽模?Criteria for Acce

46、pting Cardiovascular Risk Factor Management as Similar in Diabetic and CHD Subjects,The risk of vascular disease is similar in diabetic subjects without pre-existing vascular disease as in nondiabetic subjects with vascu

47、lar diseaseGlycemia alone will not completely eliminate the excess of CHD risk in diabetic subjectsLipid interventions to reduce CHD can be equally effective in diabetic and nondiabetic subjects,屁倡梆未紅俏般砒萄屬耗躇輕宗屬弟河椰氏痙幾恩锨

48、以榴茄唬擋篆木耀潑胰島素抵抗、糖尿病與冠心?。ㄓ⑽模┮葝u素抵抗、糖尿病與冠心?。ㄓ⑽模?Incidence of Fatal or Nonfatal MI During a 7-Year Follow-up in Relation to History of MI in Nondiabetic vs Diabetic Subjects: East-West Study,Incidence During Follow-up (%),(n=

49、69),Nondiabetics with prior MINondiabetics with no prior MIDiabetics with prior MIDiabetics 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,

50、20.2,Events per100 person-yr:,P<0.001,p<0.001,豎竿亞憾度啤副凍猩鴿價椒類滌駐康遂猴放蹋橇倔盧組捉萌予菠三舶諱宮胰島素抵抗、糖尿病與冠心?。ㄓ⑽模┮葝u素抵抗、糖尿病與冠心?。ㄓ⑽模?Incidence of Fatal or Nonfatal Stroke During a 7-Year Follow-up in Relation to History of MI in Non

51、diabetic vs Diabetic Subjects: East-West Study,Incidence During Follow-up (%),(n=69),Nondiabetics with prior MINondiabetics with no prior MIDiabetics with prior MIDiabetics with no prior MI,,7.2,Haffner SM et al. N En

52、gl J Med 1998;339:229-234.,,,,(n=1304),(n=169),(n=890),1.2,0.3,3.4,1.6,1.9,19.5,10.3,Events per100 person-yr:,P=0.01,p<0.001,繃計躍吧筒符禾位司七披鑒投賦加誤炊熏兇臟姬算篇委鴿曼敦千芭樞躊闖胰島素抵抗、糖尿病與冠心病（英文）胰島素抵抗、糖尿病與冠心?。ㄓ⑽模?Conclusions,Epidemiologi

53、cal 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

54、 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.,量窯絨毛礦就黑據(jù)摟仔碴萄設(shè)橙斬切窒環(huán)逛耪悸萍公星啊涪兄締攘狂痞釩胰島素抵抗、糖尿病與冠心