心血管风险(一级预防).ppt

* Integrating Aggressive Medical Therapy in Diabetes * Medical therapy for each metabolic abnormality is required to reduce atherogenesis in patients with diabetes. This slide depicts the possible therapeutic options for treating hyperglycemia and insulin resistance, dyslipidemia, hypertension, and hypercoagulability (platelet activation and aggregation). TZDs = thiazolidinediones Aggressive medical therapy in diabetes * In MICRO-HOPE (MIcroalbuminuria, Cardiovascular, and Renal Outcomes – Heart Outcomes Prevention Evaluation), Kaplan-Meier curves show an early and consistent benefit of ramipril 10 mg in patients with diabetes. There was a 25% relative risk reduction in the primary outcome of MI, stroke, or CV death (P = 0.0004). In PERSUADE (PERindopril SUbstudy in coronary Artery Disease and diabEtes), treatment with perindopril 8 mg once daily for 5 years reduced the primary outcome of CV death, MI, and cardiac arrest by 19% (P = 0.131). The results of PERSUADE support and extend the observations in MICRO-HOPE to a somewhat lower risk population of patients with diabetes. MICRO-HOPE, PERSUADE: ACEIs reduce primary outcome * In MICRO-HOPE, treatment with ramipril 10 mg significantly reduced the primary outcome as well as individual outcomes (MI, total mortality, CV mortality, and stroke) in patients with diabetes. The results of PERSUADE show that all trends favored treatment with perindopril 8 mg in a somewhat lower-risk population. The relative risk reduction in PERSUADE was similar to that in the main EUROPA population. MICRO-HOPE, PERSUADE: Relative risk reductions in diabetes * The results of MICRO-HOPE demonstrate that ACE inhibition (ramipril 10 mg) has vasculoprotective as well as renoprotective effects in individuals with type 2 diabetes. The risk for overt nephropathy was reduced by 24% after 4.5 years. At baseline, 32% of patients in MICRO-HOPE had microalbuminuria. Treatment lowered the risk of nephropathy in those with and without microalbuminur