糖尿病脂代谢紊乱专家讲座.pptx

糖尿病脂代谢紊乱及其与冠心病关系糖尿病脂代谢紊乱及其与冠心病关系血脂、脂蛋白和载脂蛋白FredericksonClassificationofDyslipidemias表型分类法有利于高脂血症诊疗和治疗，不过较繁琐。简易分型法将高脂血症分为高胆固醇血症、高甘油三酯血症和混合型高脂血症CausesofSecondaryDyslipidemiasWHY?MortalityinpeoplewithdiabetesType2diabetesandCHD:7-yearincidenceoffatal/nonfatalMI(EastWestStudy)Type2diabetesandCHD:7-yearincidenceoffatal/nonfatalMI(EastWestStudy)糖尿病合并冠心病临床特点Across-sectionalaxialimagefroma56-year-olddiabeticpatientwithextensivecalcificationoftheleftanteriordescendingartery(LAD)anddiagonalbranch.AmHeartJ141(4):637-644,WHY?糖尿病脂代谢紊乱WHY?1°PreventionAFCAPS/TexCAPSLovastatin155-37%-43%2°PreventionCAREPravastatin586-23%-25%4SSimvastatin202-32%-55%LIPIDPravastatin782-25%-19%4SreanalysisSimvastatin483-32%-42%4S:IncidenceofMCEbyglucosestatusReductionofcoronaryevents*普伐他汀与糖尿病发生研究WHO?脂代谢紊乱发生率糖尿病脂代谢紊乱特点WHO?成人治疗小组第三次指南JAMA,May16,-Vol285,No.19ATPIII新内容危险原因分类生活习惯危险原因正在出现危险原因ATPIII血脂和脂蛋白分层分类TGTCLDL-C<1.7(150)<5.72(220)<3.64(140)<1.7(150)<5.2(200)<3.12(120)<1.7(150)<4.68(180)<2.6(100)降脂目标(LDL-C＜100mg/dl)：临床试验证据降脂目标(LDL-C＜100mg/dl)：血管造影证据糖尿病脂代谢紊乱AFCAPS中对低HDL-C(平均40mg/dl)和较高LDL-C(平均150mg/dl)非冠心病患者研究发觉，治疗绝对受益仅见于HDL-C<40mg/dl者。调脂治疗指征和目标-TG调脂治疗指征和目标-TGWHO?LDLTreatmentGoalsAccordingtoCHDRiskADArecommendationsbasedonLDL-Clevelsinadultswithdiabetes*WHEN?NCEPguidelinesNCEP(AdultTreatmentPanelⅢ,ATPⅢ)WHEN?急性冠脉综合症中早期应用Statins益处冠心病患者早期调脂治疗益处WHEN?糖尿病脂质紊乱患者更应主动调脂治疗糖尿病脂质紊乱患者更应主动调脂治疗HOW?糖尿病脂代谢紊乱调脂药品种类和作用机制调脂药品种类和作用机制调脂药品种类和作用机制调脂药品种类和作用机制糖尿病脂代谢紊乱糖尿病脂代谢紊乱糖尿病脂代谢紊乱TreatmentprioritiesfordiabeticdyslipidemiainadultsIV.CombinedhyperlipidemiaImprovedglycemiccontrolplushigh-dosestatinImprovedglycemiccontrolplusstatin*plusfibricacidderivative*(gemfibrozil,fenofibrate)Improvedglycemiccontrolplusresinplusfibricacidderivative(gemfibrozil,fenofibrate)Improvedglycemiccontrolplusstatin*plusnicotinicacid*(glycemiccontrolmustbemonitoredcarefully)其它调脂办法HOW?谢谢！