评估 1 型糖尿病患者的心血管风险:全面而具体的实用方法建议。

IF 3.8 3区 医学 Q2 Medicine
Diabetes Therapy Pub Date : 2024-08-01 Epub Date: 2024-07-08 DOI:10.1007/s13300-024-01616-4
Clara Viñals, Ignacio Conget, Montse Granados, Marga Giménez, Antonio J Amor
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引用次数: 0

摘要

1 型糖尿病(T1D)患者罹患心血管疾病(CVD)的风险增加,这是导致这一人群发病和死亡的主要原因。即使是血糖控制良好的患者,心血管疾病风险也会随着每一个不受控制的风险因素的增加而增加。尽管人们对 T1D 患者动脉粥样硬化的生理病理和基本机制知之甚少,而且与 T2D 患者也不尽相同,但对 T1D 患者心血管疾病风险的评估建议仍延用了针对 2 型糖尿病(T2D)的建议。对微血管并发症的评估已在 T1D 中得到充分证实,但与心血管疾病相关的并发症和风险却远非如此。除了传统的心血管并发症外,颈动脉超声还可用于对心血管疾病风险进行分层。使用特定的风险量表(如 Steno 1 型风险引擎)有助于更准确地对这些人的心血管风险进行分类。管理 T1D 患者心血管风险的基石是推广地中海饮食、严格控制血糖(任何动脉床的糖化血红蛋白 (HbA1c) 均为 50%)以及踝肱指数受损者。本文件提出了评估、分类和管理 T1D 患者心血管疾病风险的实用方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Evaluation of Cardiovascular Risk in People with Type 1 Diabetes: A Comprehensive and Specific Proposed Practical Approach.

Evaluation of Cardiovascular Risk in People with Type 1 Diabetes: A Comprehensive and Specific Proposed Practical Approach.

People living with type 1 diabetes (T1D) have an increased risk of cardiovascular disease (CVD), and it is the leading cause of morbidity and mortality in this population. CVD risk increases with each uncontrolled risk factor, even in individuals with good glycaemic control. Recommendations for assessing CVD risk in the T1D population are extended from those for type 2 diabetes (T2D) even though the physiopathology and underlying mechanisms of atherosclerosis in T1D are poorly understood and differ from those in T2D. Unlike the assessment of microvascular complications, which is well established in T1D, this is far from being the case for the comorbidities and risk associated with CVD. Aside from classical cardiovascular comorbidities, carotid ultrasound can be useful to stratify CVD risk. The utilization of specific risk scales such as the Steno Type 1 Risk Engine can help to more accurately classify cardiovascular risk in these individuals. The cornerstones of the management of cardiovascular risk in T1D are the promotion of the Mediterranean diet, tight glycaemic control (glycated haemoglobin (HbA1c) < 7%), blood pressure < 130/80 mmHg in most patients, and low-density lipoprotein (LDL) cholesterol < 100 mg/dL in moderate-risk individuals, < 70 mg/dL in high-risk individuals, and < 55 mg/dL in very high-risk individuals. Conventional medical follow-up of patients with T1D should be individualized (approximately 2-3 visits per year), and a carotid ultrasound evaluation is recommended every 5 years in the absence of significant preclinical atherosclerosis or more often in those with severe preclinical atherosclerosis. Antithrombotic therapy is recommended in those receiving secondary prevention, those with stenosis > 50% in any arterial bed, and those with an impaired ankle-brachial index. This document is a proposal of a practical approach for the evaluation, classification, and management of CVD risk in individuals living with T1D.

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来源期刊
Diabetes Therapy
Diabetes Therapy Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
6.90
自引率
7.90%
发文量
130
审稿时长
6 weeks
期刊介绍: Diabetes Therapy is an international, peer reviewed, rapid-publication (peer review in 2 weeks, published 3–4 weeks from acceptance) journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of therapeutics and interventions (including devices) across all areas of diabetes. Studies relating to diagnostics and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Diabetes Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.
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