冠状动脉疾病是糖尿病患者死亡的首要原因。[2]Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2014: estimates of diabetes and its burden in the United States. 2014. http://www.cdc.gov/ (last accessed 5 April 2016).http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf相对于非糖尿病患者,糖尿病患者的心肌梗死风险增加了 1.5 至 2 倍。糖尿病患者的冠状动脉疾病更为严重,开始于更早的年龄,治疗费用更高。患有糖尿病的男女患者的心肌梗死后生存率更低。
糖尿病是心力衰竭患者心血管疾病发病率和死亡率的独立预测因子。[156]MacDonald MR, Petrie MC, Varvani F, et al. Impact of diabetes on outcomes in patients with low and preserved ejection fraction heart failure: an analysis of the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) programme. Eur Heart J. 2008;29:1377-1385.http://eurheartj.oxfordjournals.org/content/29/11/1377.longhttp://www.ncbi.nlm.nih.gov/pubmed/18413309?tool=bestpractice.com射血分数保留(舒张性心力衰竭)患者的心血管疾病死亡或心力衰竭住院的相对风险高于低射血分数患者。
多项研究比较了 CABG 与使用药物洗脱支架的经皮介入治疗,这些研究表明,糖尿病是靶病变再狭窄的独立预测因子。[122]Scheen AJ. Drug interactions of clinical importance with antihyperglycaemic agents: an update. Drug Saf. 2005;28:601-631.http://www.ncbi.nlm.nih.gov/pubmed/15963007?tool=bestpractice.com[141]Flaherty JD, Davidson CJ. Diabetes and coronary revascularization. JAMA. 2005;293:1501-1508.http://jama.jamanetwork.com/article.aspx?articleid=200563http://www.ncbi.nlm.nih.gov/pubmed/15784875?tool=bestpractice.com对于糖尿病人群,在主要心脏不良事件(例如死亡、心肌梗死或需要重复血运重建)方面,药物洗脱支架似乎优于裸金属支架。[148]Maresta A, Varani E, Balducci M, et al. Comparison of effectiveness and safety of sirolimus-eluting stents versus bare-metal stents in patients with diabetes mellitus (from the Italian Multicenter Randomized DESSERT Study). Am J Cardiol. 2008;101:1560-1566.http://www.ncbi.nlm.nih.gov/pubmed/18489933?tool=bestpractice.com[149]Mahmud E, Bromberg-Marin G, Palakodeti V, et al. Clinical efficacy of drug-eluting stents in diabetic patients: a meta-analysis. J Am Coll Cardiol. 2008;51:2385-2395.http://www.ncbi.nlm.nih.gov/pubmed/18565394?tool=bestpractice.com[150]Garg P, Normand SL, Silbaugh TS, et al. Drug-eluting or bare-metal stenting in patients with diabetes mellitus: results from the Massachusetts Data Analysis Center Registry. Circulation. 2008;118:2277-2285.http://www.ncbi.nlm.nih.gov/pubmed/19001019?tool=bestpractice.com[151]Frye RL, August P, Brooks MM, et al. A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med. 2009;360:2503-2515.http://www.nejm.org/doi/full/10.1056/NEJMoa0805796#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/19502645?tool=bestpractice.com[152]De Luca G, Dirksen MT, Spaulding C, et al; DESERT Cooperation. Meta-analysis comparing efficacy and safety of first generation drug-eluting stents to bare-metal stents in patients with diabetes mellitus undergoing primary percutaneous coronary intervention. Am J Cardiol. 2013;111:1295-1304.http://www.ncbi.nlm.nih.gov/pubmed/23490029?tool=bestpractice.com