2型糖尿病合并动脉粥样硬化性心血管疾病患者降糖药物应用专家共识

发布时间：2019-01-06 05:19

【摘要】：动脉粥样硬化性心血管疾病(ASCVD)包括冠心病、缺血性卒中及外周动脉疾病,是2型糖尿病(T2DM)患者致死和致残的主要原因。目前国内外糖尿病防治指南均推荐,对于T2DM患者,必须加强高血糖、高血压、血脂异常、肥胖等多重心血管危险因素的综合管理,以最大限度降低心血管事件和死亡风险。近年来,由于美国FDA的强制性要求,全球已完成或正在开展一系列新型降糖药物的心血管结局研究(CVOT)。已经公布的两项CVOT显示,在伴有心血管疾病或高危因素的T2DM患者中,恩格列净和利拉鲁肽可显著降低心血管事件和死亡风险。因此,本共识建议,对于T2DM合并ASCVD患者,在选择降糖药物时,除关注降糖疗效外,还应特别注意心血管安全性问题;对于血糖控制不佳的这类患者,在二甲双胍等标准治疗的基础上可考虑优先选择具有明确心血管获益证据的降糖药物(如利拉鲁肽或恩格列净)治疗。
[Abstract]:Atherosclerotic cardiovascular disease (ASCVD), including coronary heart disease, ischemic stroke and peripheral artery disease, is the leading cause of death and disability in patients with type 2 diabetes mellitus (T2DM). At present, diabetes prevention and treatment guidelines at home and abroad recommend that for patients with T2DM, we must strengthen the comprehensive management of multiple cardiovascular risk factors, such as hyperglycemia, hypertension, dyslipidemia, obesity and so on, in order to minimize the risk of cardiovascular events and death. In recent years, due to the mandatory requirements of FDA in the United States, a series of cardiovascular outcomes of new hypoglycemic drugs have been completed or are being carried out in the world, (CVOT). Two published CVOT studies have shown that in T2DM patients with cardiovascular disease or high risk factors, Englicine and riarutine significantly reduced the risk of cardiovascular events and death. Therefore, this consensus suggests that patients with T2DM combined with ASCVD should pay special attention to cardiovascular safety in addition to the efficacy of hypoglycemic drugs when choosing hypoglycemic drugs. On the basis of standard treatment such as metformin, hypoglycemic drugs with clear evidence of cardiovascular benefits (such as Rilarutide or Englicine) may be considered as a priority for patients with poorly controlled blood glucose.
【作者单位】：北京大学第三医院内分泌科;解放军总医院内分泌科;北京大学人民医院内分泌科;北京大学第一医院内分泌科;北京大学第一医院心内科;南京鼓楼医院内分泌科;四川大学华西医院内分泌科;北京安贞医院肾内科;流行病研究室;第四军医大学唐都医院内分泌科;火箭军总医院内分泌科;中山大学孙逸仙纪念医院内分泌科;哈尔滨医科大学附属第一医院内分泌科;北京协和医院内分泌科;南昌大学第一附属医院内分泌科;上海交通大学附属第一人民医院内分泌科;广西医科大学附属第一医院内分泌科;上海交通大学医学院附属新华医院内分泌科;兰州大学第一医院内分泌科;广州军区武汉总医院内分泌科;重庆医科大学附属第二医院内分泌科;安徽省立医院内分泌科;中日友好医院内分泌科;
【分类号】：R54;R587.1

【参考文献】