糖尿病的主要罹病率和死亡率部分起因於動脈粥樣硬化的大血管疾病-包括周邊血管疾病，腦血管疾病和冠狀動脈疾病。雖然控制血糖對心血管的好處還須更多的資料來建立，許多的介入性治療對改善高危險糖尿病病人的心血管風危險有幫忙。
依據可獲得的實證醫學的資料，大部分臨床治療指引對糖尿病病人可有效減少大血管疾病的治療建議如下： (1)阿斯匹靈(或clopidogrel)和血管緊縮素轉換酵素抑制劑(ACEI)可用於所有糖尿病病人併心血管疾病或年紀大於40歲的患者; (2) statin治療應處方給有血脂異常的患者的或年紀大於40歲併總膽固醇大於135 mg/dl的患者; (3)糖尿病病人有高血壓可接受乙型交感神經阻斷劑、血管緊縮素轉換酵素抑制劑(ACEI)、血管緊縮素接受器阻斷劑(ARB)和利尿劑治療; (4)即使沒有高血壓，年紀大於55歲併至少另一個心血管危險因子的糖尿病病人，可考慮使用血管緊縮素轉換酵素抑制劑(ACEI); (5)對接受冠狀動脈支架的糖尿病患者，藥物支架能減少標的血管需要再處理(TLR)的危險; (6)糖尿病患者伴隨複雜的冠狀動脈疾病，冠狀動脈繞道手術(CABG)是首選的治療策略。
The major cause of morbidity and mortality from diabetes is partly from atherosclerotic macrovascular disease – including peripheral, cerebrovascular, and coronary artery disease. Although the cardiovascular benefits of glycemic control have yet to be clearly established, a number of therapeutic interventions improve cardiovascular risk among the high-risk cohort of patients with diabetes.
Based on available evidence-based medicine data, the most iterations of clinical practice guidelines for the care of patients with DM to reduce the risk of macrovascular disease recommend the followings: (1) aspirin (or clopidogrel) and angiotensin-converting enzyme (ACE) inhibitor use for all patients with diabetes with cardiovascular disease (CVD) or > 40 years old; (2) statin therapy for patients with dyslipidemia or for all patients > 40 years old with a total cholesterol > 135 mg/dl; (3) β-blockers, ACE inhibitors, angiotensin receptor blockers (ARB) and thiazide diuretics for patients with hypertension; (4) Even in the absence of hypertension, consider an ACE inhibitor for all patients > 55 years old with at least one additional cardiovascular risk factor; (5) In the diabetics receiving coronary stent, drug-eluting stent could reduce the risk of target lesion revascularization; (6) For those with complicated coronary artery disease, coronary artery bypass grafting is the preferred strategy in the diabetics. |
