부산대학교 도서관

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjcard.2007.03.002 Byline: David C. Goff (a)(b), Hertzel C. Gerstein (c), Henry N. Ginsberg (d), William C. Cushman (e), Karen L. Margolis (f), Robert P. Byington (a), John B. Buse (g), Saul Genuth (h), Jeffrey L. Probstfield (i), Denise G. Simons-Morton (j) Abstract: Patients with type 2 diabetes mellitus die of cardiovascular disease (CVD) at rates 2-4 times higher than patients without diabetes but with similar demographic characteristics. The prevalence of diabetes is increasing in the United States and, thus, the prevention of CVD in patients with diabetes poses an urgent public health challenge. The objective of this report is to review the current knowledge base for the prevention of CVD in patients with diabetes, with particular emphasis on the control of glycemia, lipids, and blood pressure. Epidemiologic analyses suggest that each 1% increase in glycosylated hemoglobin increases the risk for CVD by approximately 18%; however, evidence from the randomized trials that have examined whether glucose lowering reduces this risk is conflicting. Randomized trials have shown that lowering low-density lipoprotein cholesterol reduces CVD event rates by 17%-43% in patients with diabetes. Limited data support a role for lowering triglycerides and increasing high-density lipoprotein cholesterol in the prevention of CVD. Evidence from clinical trials shows that reducing systolic blood pressure to Author Affiliation: (a) Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA (b) Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA (c) Department of Medicine and the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (d) Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA (e) Memphis Veterans Affairs Medical Center, Memphis, Tennessee, USA (f) Berman Center for Outcomes & Clinical Research, Hennepin County Medical Center, Minneapolis, Minnesota, USA (g) Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA (h) Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA (i) Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA (j) Clinical Applications and Prevention Branch, Division of Prevention and Population Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA. Article Note: (footnote) This work was supported by Contract Nos. N01-HC-95178, N01-HC-95179, N01-HC-95180, N01-HC-95181, N01-HC-95182, N01-HC-95183, N01-HC-95184, IAA #Y1-HC-9035, and IAA #Y1-HC-1010 from the National Heart, Lung, and Blood Institute (NHLBI), with additional support from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the National Eye Institute (NEI), the National Institute on Aging (NIA), and the Centers for Disease Control and Prevention (CDC). General Clinical Research Centers provide support at many sites.