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1、10th South China International Congress of CardiologyACE trial symposiumPrognostic and potential therapeutic implications of the European and China Heart surveysLars RydnKarolinska InstitutetStockholm, Sweden宏护幅么微盐爆蝇跨祥判众掺俐梭茹释昔巨睹元砾赊媒镀腥服圭燕只盼捏欧洲中国心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英文课件Implications o
2、f the European and China Heart SurveysImplications of the European and China Heart SurveysEuropean Guidelines on Diabetes, prediabetes and Cardiovascular Disease may be downloaded fromhttp:/www.escardio.org http:/www.easd.org慨姓尽午乔宜尝着揩鸭泊泥耿测梭焉且盼养寨骚须店薯苏尤实谐涩祭咋蹭欧洲中国心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英
3、文课件Implications of the European and China Heart SurveysImplications of the European and China Heart Surveys Diabetes and prediabetes is more common among Diabetes and prediabetes is more common among patients with coronary artery disease than imaginedpatients with coronary artery disease than imagin
4、ed伤十屉匆益熙贫敌敌芋狙咱涩肚码屉朴拨玖超肚旅屑煞狸稿厅公扭呢舍拨欧洲中国心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英文课件 GAMI1 n=16434% Normoglycaemia Prediabetes Type 2 diabetes 35%31% (1. Norhammar et al. Lancet. 2002;359:21404)Dysglycemia and coronary artery diseaseDysglycemia and coronary artery diseaseGlucometabolic category by OGTT
5、in patients without known perturbations Glucometabolic category by OGTT in patients without known perturbations EHS2n=1,920CHS3n=2,26336% 37%27% 45% 37%18% (2. Bartnik et al. Eur Heart J. 2004;25:188090)(3. Hu et al. Eur Heart J. 2006;27:25739)沟贺卷睬水胡壶悉伸敖炕腑吾贼宁易皿谚灶镜段鞘络授署勇脉蝶艾朽颖俞欧洲中国心脏调查预后和潜在的治疗意义-英文课件欧
6、洲中国心脏调查预后和潜在的治疗意义-英文课件DMIGTIFGNormalOGTTOGTTFPGWHOFPGADA020406080100%WHO 1999 criterion (FPG 6.1 mmol/l)ADA 2003 criterion(FPG 5.6 mmol/l) 8%5%21%27%5%8%8% of all with OGTT(Bartnik, Rydn et al Heart 2007; 93:72)Dysglycemia and coronary artery diseaseDysglycemia and coronary artery diseaseClassificat
7、ion according to FPG or OGTTClassification according to FPG or OGTT侨抑孪铺多省夸潘靖碍着下搪唁融缸蔼镐冤匠灼狐旗续球邹缠桶裳熏署颜欧洲中国心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英文课件Mortality in CVDMortality in CVDRelation to fasting and postprandial glycemia in patients without diabetesRelation to fasting and postprandial glycemia in
8、patients without diabetes00.511.522.57.811.1Fasting glucose (mmol/L)OGTT (mmol/L)Relative riskAdjusted for age, gender and area(The DECODE study group Lancet 1999; 354:617)秉剑定店凌贴苍侠闽搬屈池畸木盐梦厩金众晨扇贱航昌贡翠拭搂渝统祁争欧洲中国心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英文课件Guideline recommendationsGuideline recommendations
9、Recommendation ClassRecommendation Class Level LevelEarly stages of hyperglycemia and asymptomaticEarly stages of hyperglycemia and asymptomaticI IB Btype 2 DM best diagnosed by an OGTT that givestype 2 DM best diagnosed by an OGTT that givesfasting and 2-hour post-load glucose valuesfasting and 2-h
10、our post-load glucose values淮禽跟抉厌北尸箭右侈捐玄展址郁雾旅师倘渭泄育交篱犁激图蒲控塌碍柞欧洲中国心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英文课件 Diabetes and prediabetes is more common among Diabetes and prediabetes is more common among patients with coronary artery disease than imaginedpatients with coronary artery disease than imagine
11、d Newly detected dysglycemiaNewly detected dysglycemiarelates to relates to impaired impaired prognosisprognosisImplications of the European and China Heart SurveysImplications of the European and China Heart Surveys更磋可心节罐慑羌呆薪纹淫劳专池噎原蚀搅杀轩额候自拈妥蚁枕窗决伶荤欧洲中国心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英文课件RR 199
12、5-1998 =1.42RR 1995-1998 =1.42RR 1999-2002 =1.31RR 1999-2002 =1.311995199519961996199719971998199819991999200020002001 2001 2002 2002YearYearMortality (%)Mortality (%)3030202010100 0NoNoYesYesThe Swedish CCU registry 1995 - 2002 Time trends in 1-year mortality in patients with AMITime trends in 1-ye
13、ar mortality in patients with AMI) )Patients with (n= 14 873) and without (n=50 009) diabetes From the Swedish National Registry for MIDiabetesDiabetes(Norhammar et al Heart J 2007; 93:1577 )云讽衷馈铀皿证昆积吮尖蛰袍检都眩割桔骤爹廊碘蘑秒院站簇反掠焕冠屹欧洲中国心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英文课件OGTT at discharge (n= 168)DM33%
14、NGT33%IGT34%Abnormal 67%Abnormal 67%Follow-up time (months)0NormalAbnormalProbability of event free survival two-sided p = 0.0021020304050Time to Major Cardiovascular Event0.00.80.71.00.9GAMI - major cardiovascular eventsGAMI - major cardiovascular events(Bartnik et al Europ Heart J 2004; 25:1990)Gl
15、ucometabolicstate戴鸯材插溪涸讼威盆榨疚辱偷云炸踊柳唇懂晾秀洋肥矗禽枷料跑绩诧逻香欧洲中国心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英文课件Euro Heart Survey diabetes and the heartEuro Heart Survey diabetes and the heartSurvival in relation to glucometabolic stateSurvival in relation to glucometabolic state(Lentzen et al Europ Heart J 2006; 27
16、:2969)Known DMNew DM1.000.940.960.980100200400300Follow up time (days)0.92NormalIGTLog rank test p 0.001Survival probabilityGlucometabolic state俗陶孝孝抿继会髓们士辰干缔舱侈醚裁趴耻处务禽倘锅卑鹊酥纹炯腊止疹欧洲中国心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英文课件Guideline recommendationsGuideline recommendationsRecommendation ClassRecommen
17、dation Class Level LevelThe definition and diagnostic classification of DM andThe definition and diagnostic classification of DM andI IB Bprestates should be based on the level of subsequentprestates should be based on the level of subsequentrisk for cardiovascular complicationsrisk for cardiovascul
18、ar complicationsInformation on post-load glucose provides betterInformation on post-load glucose provides betterI IA Ainformation about future risk for CV disease thaninformation about future risk for CV disease thanfasting glucose, and elevated post-load glucose fasting glucose, and elevated post-l
19、oad glucose also predicts increased CV risk in subjects withalso predicts increased CV risk in subjects withnormal fasting glucosenormal fasting glucose币嘉宵搓啸疾取霜岸壮佬载漆界喳炬陇粪弧同愈苟造根匙谣模右蠕冤嚷玉欧洲中国心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英文课件Implications of the European and China Heart SurveysImplications of th
20、e European and China Heart Surveys Diabetes and prediabetes is more common among Diabetes and prediabetes is more common among patients with coronary artery disease than imaginedpatients with coronary artery disease than imagined Newly detected dysglycemiaNewly detected dysglycemiarelates to relates
21、 to impaired impaired prognosisprognosis A multifactorial risk factor management importantA multifactorial risk factor management important瞳脱材骤管庙工擞们墙壹喝否嘲租通扇伯滴默悬蕉碍譬庙坤二铀芽降浑涡欧洲中国心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英文课件Dysglycemia and cardiovascular risk a continuumDysglycemia and cardiovascular risk
22、a continuum808060604040303010105 5808060604040303010105 5Systolic blood pressure (mm Hg)Systolic blood pressure (mm Hg)Serum cholesterol (mmol/L)Serum cholesterol (mmol/L)No diabetesNo diabetesDiabetesDiabetes110 120 130 140150 1604 45 56 67 7Ten-year CHD mortality (per 1000)(Stamler et al Diabetes
23、Care 1993; 16:434)斩探凉和坞勋绎蔬冶鞋清脖习尸晚会胡勃仟集蔑机了芍栅愁捡敬兑募钱往欧洲中国心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英文课件Multifactorial intervention in type 2 diabetesMultifactorial intervention in type 2 diabetesThe Steno 2 study - 8 year follow up The Steno 2 study - 8 year follow up (Gaede et al New Engl Med 2003; 348:38
24、3)ConventionalConventionalIntensive Intensive Microvascular4 yearsn=80n=80Type 2 DM+ MAUn=160Microvascular4 yearsMacrovascular8 yearsMacrovascular8 yearsPrimaryendpoint199319972001Study protocol搂坠捻藕皂抵奠削碰电尚浓茎称沟女沏南杏篱尖戏习梆网晴酞喳坯蕴铜扁欧洲中国心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英文课件Project team every 3 monthsP
25、roject team every 3 monthsStrict therapeutic targetsStrict therapeutic targetsBehavioural modificationBehavioural modification fat 30% (satur 10%) fat 30% (satur 10%) exercise 30 min x3-5/week exercise 30 min x3-5/week smoking cess courses smoking cess coursesVitamin supplementationVitamin supplemen
26、tationStepwise introduced drugsStepwise introduced drugsHypoglycemic regimenHypoglycemic regimen according to strict rules according to strict rulesBy their GPBy their GPGuidelines by Guidelines by Danish Med Ass 1998 Danish Med Ass 1998 & & 2000 2000Referral if neededReferral if needed n = 53 (aver
27、age 3 times/pat) n = 53 (average 3 times/pat) Intensive treatment Intensive treatment Conventional treatmentConventional treatmentMultifactorial intervention in type 2 diabetesMultifactorial intervention in type 2 diabetesThe Steno 2 study 8 year follow upThe Steno 2 study 8 year follow up(Gaede et
28、al New Engl Med 2003; 348:383)Management principles性然脊铲慎堂官我礼幸约抵惟畅恶树吵李贝畴耸孩瘦死计及滞狄捆拇洱侮欧洲中国心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英文课件Multifactorial intervention in type 2 diabetesMultifactorial intervention in type 2 diabetesThe Steno 2 study 8 years of follow upThe Steno 2 study 8 years of follow upCom
29、posite endpointCV-death, MI or stroke, CABG or PCI, limb amputation or vascular surgeryImpact of intensive therapy onOR 95% CI Cardiovascular disease 0.47 0.24-0.73Nephropathy 0.39 0.17-0.87Retinopathy 0.420.21-0.86Autonomic neuropathy 0.370.18-0.79(Gaede et al New Engl Med 2003; 348:383)秋店分诣臀乓萧煌落坞恭
30、驭览呻塘阉撒婚窥绊鹃贸袍寥狄时虾揭鸳抉乍才欧洲中国心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英文课件MicrovascularMortality4 years13 yearsn=80n=80n=160MicrovascularMortality4 years13 yearsMacrovascular8 yearsMacrovascular8 yearsPrimaryendpoint1993199720012006Multifactorial intervention in type 2 diabetesMultifactorial intervention i
31、n type 2 diabetesThe Steno 2 study 13 years follow upThe Steno 2 study 13 years follow upConventionalConventionalIntensive Intensive Extendend study protocol(Gaede et al New Engl J Med 2008; 358: 580 )箕兹患础寐柳图淮倍示呻镣显拄甥辈狮蛛吨攀凶郝漱垢赦列落参蒲淑蕉疽欧洲中国心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英文课件Impact of intensive t
32、herapy on OR95% CIARR p-valueAll-cause mortality0.540.32-0.8920%0.015Cardiovascular mortality0.430.19-0.9413%0.036Major cardiovascular events0.410.25-0.6329%0.001Multifactorial intervention in type 2 diabetesMultifactorial intervention in type 2 diabetesThe Steno 2 study 13 year follow upThe Steno 2
33、 study 13 year follow upNumber of patients needed to treat forNumber of patients needed to treat for13 years to aviod one.13 years to aviod one.DeathDeath5 5Cardiovascular deathCardiovascular death8 8Major cardiovascular eventMajor cardiovascular event3 3Progression to nephropathyProgression to neph
34、ropathy5 5(Gaede et al New Engl J Med 2008; 358: 580 )椒恨轿彼硕磨浓须笺壶叛贴拔罐噪醋稿吧套援数卸涪治舔鳞兹阻目绅耗鹏欧洲中国心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英文课件Euro Heart Survey diabetes and the heartEuro Heart Survey diabetes and the heartImpact of Evidence Based Medicine on 1-year prognosisImpact of Evidence Based Medicine o
35、n 1-year prognosisEvidence based medicineThe combined use of -blockade,RAA-inhibition, antiplatelets and statins if not contraindicatedRevascularizationthrombolysis, PCI or CABGduring index hospitalisation (Anselmino et al Europ J Cardiovasc Prev Rehab 2008; In press) 茂柬若丸馅芝峭邢上嫉卞迸悸盖删济弓囤帐勺斌欣寡釜悲旗辟丸傣霉丝
36、低欧洲中国心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英文课件p0.00101002003004000,910,920,930,940,950,960,970,980,991,00No DM EBM +No DM EBM - DM EBM +DM EBM - Euro Heart Survey diabetes and the heartEuro Heart Survey diabetes and the heartImpact of Evidence Based Medicine (EBM) on 1-year mortalityImpact of Evide
37、nce Based Medicine (EBM) on 1-year mortalityTime of follow up (days)Cumulative survival(Anselmino et al Europ J Cardiovasc Prev Rehab 2008; In press) 嫂贼纫承帖劳清撵哟什枢柿氰揖前医泰剖淘汹帘马疡粘耪皱莉铁雷拣赎杂欧洲中国心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英文课件Euro Heart Survey diabetes and the heartEuro Heart Survey diabetes and t
38、he heartImpact of Evidence Based Medicine (EBM) on 1-year CVEImpact of Evidence Based Medicine (EBM) on 1-year CVE0,820,860,900,940,981,00p0.0010100200300400No DM EBM +No DM EBM - DM EBM +DM EBM - Time of follow up (days)Cumulative survival(Anselmino et al Europ J Cardiovasc Prev Rehab 2008; In pres
39、s) 回刑嫉挪益矾糟惦丢就托捷颗盲彰愉屠鞭替巷扰栈镭哑吴醋诌完喊厨萄剐欧洲中国心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英文课件p0.00101002003004000,910,920,930,940,950,960,970,980,991,00DM RV +DM RV - No DM RV +No DM RV - Euro Heart Survey diabetes and the heartEuro Heart Survey diabetes and the heartImpact of Revascularisation on 1-year mortal
40、ityImpact of Revascularisation on 1-year mortalityCumulative event free rateTime of follow up (days)(Anselmino et al Europ J Cardiovasc Prev Rehab 2008; In press) 烟镭氏城揭衣痞鸽农悍壕通雀涝署穿凳聋饭秃肉荷夏赋栈扣埂褂汤灼秤瓮欧洲中国心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英文课件p0.0010,800,820,840,860,880,900,920,940,961,00Time of follo
41、w up (days)0100200300400No DM RV +No DM RV - DM RV +DM RV - 1,00Euro Heart Survey diabetes and the heartEuro Heart Survey diabetes and the heartImpact of Revascularisation on 1-year cardiovascular eventsImpact of Revascularisation on 1-year cardiovascular eventsCumulative event free rate(Anselmino e
42、t al Europ J Cardiovasc Prev Rehab 2008; In press) 篱脯裙燃尽芍簿欢贝饶孪旬铬桂痪法贞埃订轻霜焊距闷辩眶漳镑乍凿拌唉欧洲中国心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英文课件Euro Heart Survey diabetes and the heartEuro Heart Survey diabetes and the heartNumber needed to treat (NNT) with EBM and RevascularisationNumber needed to treat (NNT) wit
43、h EBM and Revascularisation Treatment type Diabetes NNT to avoid one event Fatal CardiovascularEvidence BasedNo1826141MedicineYes2432RevascularisationNo10541Yes3414Evidence Based MedicineRevascularization(Anselmino et al Europ J Cardiovasc Prev Rehab 2008; In press) 超蜗定沉喀蜗格缅修韦府羽抠碍裹蛰壶弯乘碧纶搅吹握匙雹绑晋各凑阐慈欧
44、洲中国心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英文课件Guideline recommendationsGuideline recommendationsLifestyle modification Structured educationStructured educationSmoking cessation Smoking cessation ObligatoryObligatoryBP BP 130 / 80 mm Hg 130 / 80 mm Hg Renal dysf 125/75 Renal dysf 125/75HbA1c (DCCT sta
45、ndard) HbA1c (DCCT standard) 6.5%6.5%mmol/lmmol/lmg/dlmg/dlVenous plasma glucoseVenous plasma glucose6.06.0108108 Cholesterol Cholesterol 4.54.5175175 LDL LDL 1.81.0; female 1.2male 1.0; female 1.240; 7640; 76Triglycerides Triglycerides 1.71.7150150Variable Target稠该方笆孽缀踊坦犹症祝凳且捉莎厉沏毕砂姻厩阁魏摧早教魄娄髓线结新欧洲中国
46、心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英文课件Implications of the European and China Heart SurveysImplications of the European and China Heart Surveys Diabetes and prediabetes is more common among Diabetes and prediabetes is more common among patients with coronary artery disease than imaginedpatients w
47、ith coronary artery disease than imagined Newly detected dysglycemiaNewly detected dysglycemiarelates to relates to impaired impaired prognosisprognosis A multifactorial risk factor management importantA multifactorial risk factor management important Glucose controlGlucose control In patients with
48、established diabetes In patients with established diabetes In patients with newly detected glycemic perturbations In patients with newly detected glycemic perturbations寞痒险宠疫社莲屠莫丰烫咳丘榨扦评忱录蠕厦掷州岗违习蜗咋工先靳趣额欧洲中国心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英文课件with CADwith CAD(Stettler C et al. Am Heart J 2006; 15
49、2: 27)PeripheralCardiacCerebrovascularAny macrovascularIncidence Rate RatioGlycemic controlGlycemic controlEvidence for impact on cardiovascular eventsEvidence for impact on cardiovascular events传构甸擅山瀑性童姨厕征膳汝谋酵姥明哈滋两者裤兼掂氟特运么灭事禾悲欧洲中国心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英文课件Glycemic controlGlycemic co
50、ntrolEvidence for impact on cardiovascular eventsEvidence for impact on cardiovascular eventsThe STOP NIDDM trial, testing the possibility to prevent progression from impaired glucose tolerance to diabetes with acarbose.demonstrated a 49% relative risk reduction of the three-year risk for CVE compar
51、ed to placebo(Chiasson, J.L. et al. JAMA 2003; 290: 486)应呆肩堵辩毯坯瞅娠茁雾趣粒漠穴蔽啥懈晒缴狭漂痛手坞淌螺卡璃录耿批欧洲中国心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英文课件Glycemic controlGlycemic controlIncidence of composite cardiovascular events in the STOP-NIDDM trialIncidence of composite cardiovascular events in the STOP-NIDDM tri
52、alFollow up time (years)Cumulative incidence (%)043215AcarbosePlacebo543210Log rank test p=0.04Cox proportional model p=0.03(Chiasson, J.L. et al. JAMA 2003; 290: 486)潭山筹鼓弥侨核欢均浚矩褒焰兄啸烽匈裂泼瞒屏瞩阐玄隙战尚黔皋旅边粕欧洲中国心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英文课件496146763940EnrolledLost to follow-upStudy populationGl
53、ucometabolic state availableGlucometabolic state unknown285*736*1819 OGTT696 FPG 947 Normal glucose regulation1116 Impaired glucose regulation1425 Known diabetes452 Newly detected diabetes452 Newly detected diabetesGlycemic controlGlycemic controlExperiences from the Euro Heart SurveyExperiences fro
54、m the Euro Heart SurveyStudy populationStudy population(Lentzen et al Europ Heart J 2006; 27:2969)绢绒伴数绿隆色阵造献歹稻熬减垣吁斡哦颈住汽寻必锚妥炼隐纪私摄妈陈欧洲中国心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英文课件Prescribed Prescribed glucose glucose lowering drugs lowering drugs 77 (17%) 77 (17%) 1%16%1%83%InsulinOral drugsCombination
55、sNo prescriptionNewly detected diabetesn = 452Not prescribedglucose lowering drugs 375 (83%) Glycemic controlGlycemic controlExperiences from the Euro Heart SurveyExperiences from the Euro Heart SurveyGlucose lowering drugs at follow up in patients with newly detected diabetesGlucose lowering drugs
56、at follow up in patients with newly detected diabetes(Anselmino et al; Europ Heart J 2008; 29:177) 浦供倾沛嘘爱阐蝗写犊蔬伴甫钮呕烹油翘厩模层扩装厘倍庸晴琐盘右锻赣欧洲中国心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英文课件0,900,920,940,960,981,00Log rank testp=0.047YesNo0100200300400Cumulative event free rateTime of follow up (days)Glucose low
57、ering drugEuro Heart Survey diabetes and the heartEuro Heart Survey diabetes and the heartImpact of glucose lowering drugs on 1-year CV-events (Kaplan-Meier)Impact of glucose lowering drugs on 1-year CV-events (Kaplan-Meier)(Anselmino et al; Europ Heart J 2008; 29:177) 魔见碱栓今梁捐抹鲁赣泛昔植债伴贺底迄搞骆总皿刃痛慷糯狮抖既赚
58、釉仓欧洲中国心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英文课件Euro Heart Survey diabetes and the heartEuro Heart Survey diabetes and the heartHR for the impact of GLD on 1-year CV events in newly detected DMHR for the impact of GLD on 1-year CV events in newly detected DM0.041(0.05-0.97)0.220.043(0.02-0.97)0.13p(
59、95%CI)HR 0.5 1.0 1.5All-causemortality/MICV mortality, MI or strokeVariableAdjusted for age, sex, previous cardio-vascular diseases and use of evidence-based treatments(Anselmino et al; Europ Heart J 2008; 29:177) 眷况得损悔贫套湾拉碰被研犬株国聪早乎崩线瞄渊耙书漆晤停烯拄肌旷攘欧洲中国心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英文课件Guidelin
60、e recommendationsGuideline recommendationsRecommendation Class LevelImproved control of post-prandial glycemia may IIbClower CV risk and mortality Need for further research Available data promising烩履偿殿蚂吊涕剩苯灌聪簇汪完班箭若店缓嫩苔暂畏焊玛韶沾齐乞纱剂嘘欧洲中国心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英文课件10th South China International Congress of CardiologyACE trial symposiumPrognostic and potential therapeutic implications of the European and China Heart surveysTime for questions尘诗适天硷湍逆更初荷酣浚慈牟筐枉樊捧州柯咙帆拣扭该忆湘脾攒胺找捞欧洲中国心脏调查预后和潜在的治疗意义-英文课件欧洲中国心脏调查预后和潜在的治疗意义-英文课件
