胰島素抵抗糖尿病與冠心病(英文)課件

1、第一頁，共三十頁。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)第二頁，共三十頁。0123456789DevelopedDeveloping

2、PercentKing H et al. Diabetes Care 1998;21:1414-1431.World199520002025第三頁，共三十頁。American 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 costsOthers

3、Ophthalmic diseaseCardiovasculardiseaseRenal diseaseNeurologic diseasePeripheral vascular disease第四頁，共三十頁。024681012141618Annual CHD Deaths per 1000 PersonsKannel WB, McGee DL. JAMA 1979;241:2035-2038.第五頁，共三十頁。01020304050Ischemicheartdisease% of DeathsGeiss LS et al. In: Diabetes in America. 2nd ed.

4、1995; chap 11.OtherheartdiseaseDiabetesCancerStrokeInfectionOther第六頁，共三十頁。05101520253035Mortality per 1000 person-years*Age-adjustedAdapted from Gu K et al. Diabetes Care 1998;21:1138-1145.29.919.2MenWomenAll heart diseaseIschemic heart diseaseMenWomen11.56.323.07.111.03.6第七頁，共三十頁。05101520 *Defined

5、in 1971-1975, followed up through 1982-1984.*Defined in 1982-1984, followed up through 1992-1993.Gu K et al. JAMA 1999;281:1291-1297.17.06.814.27.67.44.22.41.9(P=0.46)(P=0.76)(P200 mg/dl, smoking, SBP 120 mmHgStamler J et al. Diabetes Care 1993;16:434-444All threeNo diabetesDiabetesTwo only第十一頁，共三十頁

6、。BLACK BOXn Dyslipidemian Hypertensionn Hyperinsulinemia/insulin resistancen Hemostatic abnormalitiesn Hyperglycemian AGE proteinsn Oxidative stressAGE = advanced glycation end productsAdapted from Bierman EL. Arterioscler Thromb 1992;12:647-656.第十二頁，共三十頁。 + = moderately increased compared with nond

7、iabetic population+ = markedly increased compared with nondiabetic population = not different compared with nondiabetic populationDyslipidemia Hypertriglyceridemia Low HDL Small, dense LDL Increased apo BHypertensionHyperinsulinemia/insulin resistanceCentral obesityFamily history of atherosclerosisC

8、igarette smokingAdapted from Chait A, Bierman EL. In: Joslins Diabetes Mellitus. Philadelphia: Lea & Febiger, 1994:648-664.+第十三頁，共三十頁。Howard BV et al. Diabetes Care 1998; 21:1258-1265.0-2-4-6-8Differences between participants with and without diabetes0-2-4-6-8mg/dL第十四頁，共三十頁。n Microvascular compl

9、ications- Aggressive screening- Improved metabolic controln Macrovascular complications- Improved 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

10、risk第十五頁，共三十頁。01020304050110120130140150160170Incidence per 1000 Person Years (%)Adler AI et al. BMJ 2000;321:412-419.Updated Mean Systolic Blood Pressure (mmHg)Adjusted for age, sex, and ethnic groupMyocardial InfarctionMicrovascular Endpoints第十六頁，共三十頁。020406080567891011Incidence per 1000 Person Ye

11、ars (%)Stratton IM et al. BMJ 2000;321:405-412.Updated Mean Hemoglobin A1c Concentration (%)Adjusted for age, sex, and ethnic groupMyocardial InfarctionMicrovascular Endpoints第十七頁，共三十頁。Despres JP et al. N Engl J Med 1996;334:952-957.0.02.04.06.08.0Odds Ratio15F-Insulin (U/ml)4.6p=0.005150 mg/dl150 m

12、g/dlTriglycerides1.01.55.3p=0.001P0.0016.75.4P=0.002第十八頁，共三十頁。Despres 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 B1.01.53.2p0.00111.09.7P25.6425.64LDL Peak Particle Diameter (nm)1.01.06.2(p120 mg/dl2.0120 mg/dl

13、第二十頁，共三十頁。BMI (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 + 0.02108.8 + 0.85.00 + 0.0281 + 5.472.472.0

14、06.045.004.032.006Conversion Status at Follow-up* Ratio of subscapular to triceps skinfolds第二十一頁，共三十頁。WHO. Diabetologia 1985;28:615-640; Haffner SM et al. JAMA 1990;263:2893-2898.第二十二頁，共三十頁。Lehto S et al. Diabetes 1997;46:1354-1359.403020100% IncidenceP-glucose (mmol/L)13.4403020100% IncidenceCHD Mo

15、rtalityAll CHD EventsCHD MortalityAll CHD EventsHbA1 (%)10.7第二十三頁，共三十頁。 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 s

16、ex.Turner RC et al. BMJ 1998;316:823-828.第二十四頁，共三十頁。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 i

17、nterventions to reduce CHD can be equally effective in diabetic and nondiabetic subjects第二十五頁，共三十頁。01020304050Incidence 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)3.00.57.83.23.545.020.2Events per100 person-yr:P0.001p0.001第二十六頁，共三十頁。0510152025Incidence During Follow-up (%)