全面干预,终点受益中国糖尿病患者风险管理1.pptVIP

* * OBJECTIVE--To assess predictors of CVD mortality among men with and without diabetes and to assess the independent effect of diabetes on the risk of CVD death. RESEARCH DESIGN AND METHODS--Participants in this cohort study were screened from 1973 to 1975; vital status has been ascertained over an average of 12 yr of follow-up (range 11-13 yr). Participants were 347,978 men aged 35-57 yr, screened in 20 centers for MRFIT. The outcome measure was CVD mortality. RESULTS--Among 5163 men who reported taking medication for diabetes, 1092 deaths (603 CVD deaths) occurred in an average of 12 yr of follow-up. Among 342,815 men not taking medication for diabetes, 20,867 deaths were identified, 8965 ascribed to CVD. Absolute risk of CVD death was much higher for diabetic than nondiabetic men of every age stratum, ethnic background, and risk factor level--overall three times higher, with adjustment for age, race, income, serum cholesterol level, sBP, and reported number of cigarettes/day (P < 0.0001). For men both with and without diabetes, serum cholesterol level, sBP, and cigarette smoking were significant predictors of CVD mortality. For diabetic men with higher values for each risk factor and their combinations, absolute risk of CVD death increased more steeply than for nondiabetic men, so that absolute excess risk for diabetic men was progressively greater than for nondiabetic men with higher risk factor levels. CONCLUSIONS--These findings emphasize the importance of rigorous sustained intervention in people with diabetes to control blood pressure, lower serum cholesterol, and abolish cigarette smoking, and the importance of considering nutritional-hygienic approaches on a mass scale to prevent diabetes. * * * * 1.晚期糖基化终末产物(advanced glycation end-products,AGEs)可引起体内组织一系列病理生理改变,是导致糖尿病慢性并发症的重要致病因素。 2.葡萄糖转运蛋白(GLUT) 3.蛋白激酶C(PKC) ：近年研究发现PKC的激活可能是DM多种发病机制相联系的共同纽带 。 4、MAPK：糖尿病状态下,多种因素激活 丝裂原活化蛋白激酶(MAPK)信号转导通路 。 。 * * Overnutrition and decreased physical activity lead to incr