血糖控制与心血管事件

Glycemic Control and Cardiovascular Events

目的探讨血糖控制与心血管事件之间的关系。方法通过分析ACCORD、ADVANCE和CREDIT研究,探讨血糖控制与心血管事件之间的关系。结果 (1)ACCORD项目数据分析发现:强化血糖控制组的死亡人数多于常规治疗组,相对风险增加22%,二者存在显著差异;(2)ADVANCE研究结果显示:强化治疗组的患者主要大血管和主要微血管事件的联合终点降低了10%,肾病的发生减少了21%,同时蛋白尿也减少了30%。强化治疗组对比常规治疗组,肾脏的保护作用更强,两组存在显著差异。在降低心脑血管并发症和全死亡率方面,两组没有显著差异。而强化治疗组在降低心脑血管死亡风险方面显示出有益的方面,但没有统计学意义;(3)CREDIT研究发现:Hb A1c超过平均值1%,首次卒中风险增加36%,心血管死亡风险增加31%,心肌梗死风险增加5%。结论严格"控糖"导致死亡率升高(ACCORD研究),降糖保护肾脏,无助心脏(ADVANCE研究)良好血糖控制有助于降低心血管事件。

Objective To investigate the relationship between blood glucose control and cardiovascular events. Methods Through the analysis of ACCORD, ADVANCE and CREDIT research, to explore the relationship between blood glucose control and cardiovascular events. Results （ 1 ） The ACCORD project data analysis found that： strengthening the death toll of glycemic control group than in the conventional treatment group, the relative risk increased 22%, there was significant difference between the two. （2） Metaphase ADVANCE research results announced, intensive glucose control, the HbAlc level of 6.5%, reduce the combined endpoint of 10% major vascular and microvascular events, reduces the occurrence of 21% kidney, 30% reduction in proteinuria. Intensive blood glucose control and routine treatment group compared, although can effectively protect the kidney, but for major vascular events, cardiovascular death and all-cause mortality were not significant difference; （ 3 ） The CREDIT study found that： HbAlc more than the average value of 1%, the first time a 36% increased risk of stroke, cardiovascular death risk increased by 31%, the risk of myocardial infarction increased 5%. Conclusion Intensive glycolic control can lead to increased mortality （ ACCORD study ） , protect the kidney but helpless heart （ ADVANCE study ） and help to reduce cardiovascular events （ the CREDIT study ） .