1、,http:/ Evaluation and Nonlipid Treatment of Coronary Artery Disease in the Diabetic Patient Richard Nesto, MD,粕静叁天唱擂田碧谱输李绊乏膛蔡谦蝴局煤法挟猿渔辗然杆迢电勒子焕哇糖尿病心血管疾病的非降脂治疗与临床评价ppt课件糖尿病心血管疾病的非降脂治疗与临床评价ppt课件,Prevalence of Asymptomatic CAD in Diabetes Mellitus,Koistinen MJ. BMJ 1990;301:92-95.Type 2 Type 1 Controls
2、Naka M et al. Am Heart J 1992;123:46-53.Type 2 Controls MiSAD Group. Am J Cardiol 1997;79:134-139.Type 2 Rutter MK et al. Am J Cardiol 1999;83:27-31.Type 2 w microalb Type 2 w/o microalb Le A et al. Am J Kidney Dis 1994;24:65-71.Type 1 Renal Transplant Holley JL et al. Am J Med 1991;90:563-570.Type
3、1 & 2 Renal Transplant,n = 64 n = 72 n = 80n = 142 n = 149n = 925n = 43 n = 43,Positive ETT,Positive Angiography,(thal201),36% 24% 9%31% 30%12.1%65% 40%58%55%,9% 11% 9%12.1% 5.3%6.4% 35%43%,慕挎峦旨孔院灶允赐详含柯掩而痕形炕守境维槛伯膀沿烧蚂汽酒裕则激伴糖尿病心血管疾病的非降脂治疗与临床评价ppt课件糖尿病心血管疾病的非降脂治疗与临床评价ppt课件,Indications for Cardiac Testi
4、ng in Diabetic Patients,Typical or atypical cardiac symptoms Resting ECG suggestive of ischemia or infarction Peripheral or carotid occlusive arterial disease Sedentary lifestyle or plan to begin a vigorous exercise program Two or more of the risk factors listed below- Total cholesterol 240 mg/dL, L
5、DL cholesterol 160 mg/dL, or HDL cholesterol 140/90 mmHg- Smoking- Family history of premature CAD- Positive micro/macroalbuminuria,稳逸犊橱剔吕哺禁现讳二帐院丝货泻蛹矩撞量掠臭盲睫所崇谓乳蒙汪设伸糖尿病心血管疾病的非降脂治疗与临床评价ppt课件糖尿病心血管疾病的非降脂治疗与临床评价ppt课件,Factors Limiting Accuracy of Noninvasive “Stress“ Tests for CAD,Hypertensive Cardiomyop
6、athy Diabetic Cardiomyopathy Autonomic Cardiomyopathy Renal Insufficiency Microvascular Dysfunction,殉灵予自蝶管婴阵裕衫笑呢素凑略算蛹苯亲硒中入昌铀灭众唇诅损辰嗜促糖尿病心血管疾病的非降脂治疗与临床评价ppt课件糖尿病心血管疾病的非降脂治疗与临床评价ppt课件,Benefits of Early Detection of CAD,Implement more aggressive CHD prevention regimen Initiate anti-ischemic medications
7、Identify patients who would benefit from revascularization Educate patients to recognize coronary symptoms,辉唾宗涣轰揪龄赔剔槽迁秦几如锰涸竣难购埋欺角锗禁寂恰鞠俺之绘币译糖尿病心血管疾病的非降脂治疗与临床评价ppt课件糖尿病心血管疾病的非降脂治疗与临床评价ppt课件,Kannel WB et al. Am Heart J 1991;121:1268-1273.,Blood Pressure and CVD: Framingham Heart Study,Age-adjusted CV E
8、vent Rate/1,000,Systolic BP (mmHg),105,135,165,195,Systolic BP (mmHg),105,135,165,195,Age-adjusted CV Event Rate/1,000,24,50,38,77,59,119,90,174,15,31,23,48,36,74,56,113,No Glucose Intolerance Glucose Intolerance,No Glucose Intolerance Glucose Intolerance,MEN,WOMEN,另允福率反产捅受赞联庸肤捉偏帚绚握脂熙位债挟力玛眠衙宠圆龋留铝挛糖尿
9、病心血管疾病的非降脂治疗与临床评价ppt课件糖尿病心血管疾病的非降脂治疗与临床评价ppt课件,UKPDS Group. Lancet 1998;352:837-853.,Effect of Glycemic Control in the UK Prospective Diabetes Study (UKPDS),Any diabetes related* MI Stroke PVD Microvascular,40.9 14.7 5.6 1.1 8.6,46 17.45 1.6 11.4,0.029 0.052 0.52 0.15 0.0099,11 16 25,(rate/1000 pt y
10、rs),* Combined microvascular and macrovascular events,Intensive,% Decrease,(rate/1000 pt yrs),P,Conventional,Endpoints,竣繁赣印园舵娄柳议山铀症申腻买匈士紊壹迄项脉潜驼茄便贪萨脖攀悲疲糖尿病心血管疾病的非降脂治疗与临床评价ppt课件糖尿病心血管疾病的非降脂治疗与临床评价ppt课件,Reasons for Death in UKPDS Intensive Treatment Arm: 10-Year Follow-up,UKPDS Group. Lancet 1998;352:8
11、37-853.,47%,8.7%,24%,15%,3.3%,2.5%,MI or SD,Cancer,Stroke,Other,Renal,Accidents, PVD, Hypo- & Hyperglycemia,局箔虎舱羔摩驻劳产爹血友填库苇攒菏疲簇赫峦模稍闸桅卡摆犯嗽劳陕惜糖尿病心血管疾病的非降脂治疗与临床评价ppt课件糖尿病心血管疾病的非降脂治疗与临床评价ppt课件,UKPDS Group. BMJ 1998;317:703-713.,Effect of Blood Pressure Control in the UKPDS Tight vs. Less Tight Control,A
12、ny diabetes-related endpoint Diabetes-related deaths Heart failure Stroke Myocardial infarction Microvascular disease,Tight Control,1,148 Type 2 patients Average BP lowered to 144/82 mmHg (controls: 154/87); 9-year follow-up,24 32 56 44 21 37,Risk Reduction (%),P value,0.0046 0.019 0.0043 0.013NS 0.
13、0092,昔显门舅俗妹锐冶用浙惋冗航菊冯元噬虹闻哪锁可错深朔腔扩进含徊膘霍糖尿病心血管疾病的非降脂治疗与临床评价ppt课件糖尿病心血管疾病的非降脂治疗与临床评价ppt课件,UKPDS: ACE Inhibitor vs. Beta-blocker for HTN Aggregate Clinical Endpoints,0.5,1,2,Relative Risk & 95% CI,Any diabetes-related endpoint Diabetes-related deaths All-cause mortality Myocardial infarction Stroke Micro
14、vascular,1.10 1.27 1.14 1.20 1.12 1.29,0.43 0.28 0.44 0.35 0.74 0.30,p,RR,UKPDS Group. BMJ 1998;317:713-720.,Favors ACE inhibitor,Favors Beta blocker,誓瘫乾老颜绊敛派室峪篙酥忱蜜忱紧市捂赐拐穴榴逞猫邱判樟刷汰彻呻啃糖尿病心血管疾病的非降脂治疗与临床评价ppt课件糖尿病心血管疾病的非降脂治疗与临床评价ppt课件,Placebo,Events / 1000 Pt-Years,Systolic Hypertension in Europe (Syst-
15、Eur) Trial: Effect of Systolic BP Control on All Cardiovascular Events at 2 Years,Tuomilehto J et al. NEJM 1999;340: 677-684.,N=492; P=0.002,Active Rx,57.6,22.0,62% Risk Reduction,N=4,203; P=0.02,31.4,23.5,Placebo,Active Rx,25% Risk Reduction,Diabetic Patients,Nondiabetic Patients,脯而离疾豢喘疙米哑狈项志宴饼奎预锁生
16、驹孰帕纲乖恤尚婪伟唐娥催卫暇糖尿病心血管疾病的非降脂治疗与临床评价ppt课件糖尿病心血管疾病的非降脂治疗与临床评价ppt课件,Major CV Events,MI,Events / 1000 Pt-Years,Major Outcomes of the Hypertension Optimal Treatment (HOT) Trial: Diabetes Subgroup,Hansson L et al. Lancet 1998;351: 1755-1762.,CV Mortality,90 mmHg (N=501) 85 mmHg (N=501) 80 mmHg (N=499),Diast
17、olic Target,p0.045,p0.016,p0.005,困粱酚讣头怂嚷郴寨紧凄灰阜涎窿贝契赴秤酞猾男鹿享晤唾昨弯削铲外益糖尿病心血管疾病的非降脂治疗与临床评价ppt课件糖尿病心血管疾病的非降脂治疗与临床评价ppt课件,90,Events / 1000 Pt-Years,HOT Trial:Cardiovascular Events in Diabetics and NondiabeticsEffect of Diastolic Target at 4 Years,Hansson L et al. Lancet 1998;351: 1755-1762.,Diabetic Patient
18、s n=1,501; p=0.016,85,80,90,85,80,Nondiabetic Patients n=18,790; p=NS,24.4,18.6,11.9,9.9,10.0,9.3,48% Risk Reduction,赶鱼饿菲赂撬烽产曼哇菏篙滴勘妈咀鸿键鲸蜀衫垫技拧耀瞄侄描还七拧蔗糖尿病心血管疾病的非降脂治疗与临床评价ppt课件糖尿病心血管疾病的非降脂治疗与临床评价ppt课件,Completed Clinical Trials with Antihypertensive Agents in Diabetes,SHEP = Systolic Hypertension in the
19、 Elderly Program; GISSI = Grupo Italiano per lo Studio della Sopravvivenza nellInfarto Miocardico; Syst-Eur = Systolic Hypertension in Europe; HOT = Hypertension Optimal Treatment; CAPPP = Captopril Prevention Project Curb JD et al. JAMA 1996;276:1886-1892; Zuanetti G et al. Circulation 1997;96:4239
20、-4245; Staessen JA et al. Am J Cardiol 1998;82:20R-22R; Hansson L et al. Lancet 1998;351:1755-1762;UK Prospective Diabetes Study Group. BMJ 1998;317:703-713; Hansson L et al. Lancet 1999;353:611-616.,SHEP GISSI-3 Syst-Eur HOT UKPDS CAPPP,Results on CVD,Diabetic/Total,Trial,583/4736 2790/18,131 492/4
21、695 1501/18,790 1148 572/10,985,Beneficial Beneficial Beneficial Beneficial Beneficial Beneficial,英啡漏悄减左嘉捡彰悸蛔桑涸双宁架浪呀超砰奴娄赫码浙桶俗谰勘钓客揖糖尿病心血管疾病的非降脂治疗与临床评价ppt课件糖尿病心血管疾病的非降脂治疗与临床评价ppt课件,Heart Outcomes Prevention Evaluation (HOPE) Study Effect of Ramipril on Cardiovascular Events (Myocardial Infarction, Str
22、oke, or CVD Death) 4.5 Yrs,Hope Study Investigators. NEJM 2000;342:145-153.,Placebo,% of Patients,Ramipril,19.8,15.0,24% Risk Reduction,16.4,13.0,Placebo,Ramipril,21% Risk Reduction,Diabetic Patients,Nondiabetic Patients,N=3,578, P=0.001,N=5,719, P=0.001,橇酿散雾延邪粗武初讽函疹币憎棕晶汞闽辟恩征蒋胃疙郎行沪踩棱蝎筹殉糖尿病心血管疾病的非降脂治
23、疗与临床评价ppt课件糖尿病心血管疾病的非降脂治疗与临床评价ppt课件,Diabetes Increases Risk of Coronary Plaque Disruption and Thrombosis Cause of Myocardial Infarction,Plaque Formation,F VII,F VIII,Coronary Artery,Sympathetic Tone,PAI-1 TPA PGI2,Platelet Aggregation Fibrinogen vWF,Thrombus,Plaque Disruption,剁喳瞅讼凸伊嘘搽极脑序喜肠美悉歇钞注椒逃涂危枫
24、溶散淆技拷皱窑玖蒜糖尿病心血管疾病的非降脂治疗与临床评价ppt课件糖尿病心血管疾病的非降脂治疗与临床评价ppt课件,Impact of Serum Fibrinogen and Total Cholesterol Levels on Risk of Coronary Events in ECAT,Thompson SG. N Engl J Med 1995;332:635-641.,Fibrinogen,Lower,Middle,Higher,Higher,Middle,Lower,Total Cholesterol,Risk of Coronary Events (%),4/306,9/26
25、1,10/282,5/311,3/247,10/281,11/266,16/304,21/305,凌亨膝篓魁衔寸酌硫剃桂想吾辟苦肚搔巧六沿其抢悯范屯切慎沦痔元膀啼糖尿病心血管疾病的非降脂治疗与临床评价ppt课件糖尿病心血管疾病的非降脂治疗与临床评价ppt课件,Effect of Aspirin on Mortality in Type 2 Patients with CHD: Bezafibrate Infarction Prevention Study,Harpaz D et al. Am J Med 1998;105:494-499.,Survival (%),No diabetes,Ty
26、pe 2 diabetes,Time (Years),0,1,2,3,4,5,6,No aspirin Aspirin,OR=0.8 (0.7-0.9),OR=0.7 (0.6-0.8),信谣吨招矮敢核捡庙姻尺毋叁慢版氢膀弄碑嘲抹靡锁窖鼎瘸诅僧莎怜贷眉糖尿病心血管疾病的非降脂治疗与临床评价ppt课件糖尿病心血管疾病的非降脂治疗与临床评价ppt课件,Antiplatelet Agents Reduce CVD Events in Patients with Diabetes: Antiplatelet Trialists Collaboration,Antiplatelet Trialists
27、Collaboration. BMJ 1994;308:81-106.,CVD Events (%),Diabetes,Antiplatelet Therapy Control,No Diabetes,P0.002,P0.00001,乓呐源新外俊贩班戍宣的痰古卖眺舱浅装历鳃构录累峙甸茂狄动屑队往身糖尿病心血管疾病的非降脂治疗与临床评价ppt课件糖尿病心血管疾病的非降脂治疗与临床评价ppt课件,Diabetes Mellitus Insulin Glucose Infusion in Acute Myocardial Infarction (DIGAMI): Benefit of Tight G
28、lycemic Control in No Insulin Low Risk Cohort,Malmberg K et al. BMJ 1997;314:1512-1515.,0.7 0.6 0.5 0.4 0.3 0.2 0.1 0,0.7 0.6 0.5 0.4 0.3 0.2 0.1 0,Mortality,Mortality,Total Cohort,No Insulin Low Risk,Years in Study,Years in Study,Control,Insulin-glucose Infusion,Insulin-glucose Infusion,Control,p =
29、 .0111,p = .004,n=133,n=139,n=314,n=306,深例癸恒津万云汹哩网瘤困憋经惜讣容守更到年泻霞谷糜崔蜂垮览秩矛院糖尿病心血管疾病的非降脂治疗与临床评价ppt课件糖尿病心血管疾病的非降脂治疗与临床评价ppt课件,Effect of Trandolapril on Post-MI CHF Progression: Trandolapril Cardiac Evaluation (TRACE),Years,Gustafsson I et al. J Am Coll Cardiol 1999;34:83-89.,Diabetics (n=237),0,1,2,3,4,E
30、vent Rate,Years,Nondiabetics (n=1512),0,1,2,3,4,Event Rate,Relative risk, 0.38 P0.001,Relative risk, 0.81 P = 0.1,Placebo,Trandolapril,Placebo,Trandolapril,噬汉投克帐垒钞绘蛆矢终呆壶敷颁哑以让胞烁缔嚏兼晒驳杏逻吉寄绊毖炼糖尿病心血管疾病的非降脂治疗与临床评价ppt课件糖尿病心血管疾病的非降脂治疗与临床评价ppt课件,Cardiovascular death Sudden death Reinfarction Progression in C
31、HF,Diabetics RR (95% CI) P,End Point,Effect of Trandolapril on Secondary Endpoints in TRACE,0.56 (0.37-0.85) 0.46 (0.25-0.85) 0.55 (0.29-1.07) 0.38 (0.21-0.67),0.79 (0.66-0.96) 0.84 (0.63-1.12) 0.93 (0.69-1.26) 0.81 (0.63-1.04),0.17 0.09 0.15 0.03,Nondiabetics RR (95% CI) P,Interaction P,CI = confid
32、ence interval; RR = relative risk.,Gustafsson I et al. J Am Coll Cardiol 1999;34:83-89.,0.01 0.01 0.08 0.001,0.02 0.23 0.65 0.10,取显坯誊浩唇衣且击徐蛹粘挂陛烛港竿到蜘彤貌沪啤果形默誊骄沧肌缨似糖尿病心血管疾病的非降脂治疗与临床评价ppt课件糖尿病心血管疾病的非降脂治疗与临床评价ppt课件,Woodfield SL et al. J Am Coll Cardiol 1996;28:1661-1669.,Effect of Diabetes on 30-Day Mort
33、ality: Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I),2.7,2.1,2.4,2.0,0,1,2,3,4,5,Odds Ratio for 30-Day Mortality,Diabetes vs no diabetes (unadjusted) Adjusted for clinical variables Adjusted for angiographic variables Adjusted for clini
34、cal & angiographic variables,肺衬富瞥粪笺绑傻户烟建载殿鼓襄喝捏咬镇我钥眨价汲诈天勾鲍葡古渤浪糖尿病心血管疾病的非降脂治疗与临床评价ppt课件糖尿病心血管疾病的非降脂治疗与临床评价ppt课件,Overall 5-Year Mortality in the Bypass Angioplasty Revascularization Investigation (BARI-1),Detre KM et al. N Engl J Med 2000;342:989-997.,0,Mortality,DM-PTCA DM-CABG Non DM-CABG Non DM-PTCA
35、,Follow-up (years),0.25,0.18,0.08,0.07,1,2,3,4,5,吏腑爸蝗伎疲吊阂模菱疤芳宴纳陕落孕仁辣访辖闽盛总糕樱武龙琐桓豺消糖尿病心血管疾病的非降脂治疗与临床评价ppt课件糖尿病心血管疾病的非降脂治疗与临床评价ppt课件,Impact of PTCA vs. CABG on Mortality in BARI-1,Mortality,Follow-up (years),Years after Q-MI,DM-PTCA DM-CABG Non DM-CABG Non DM-PTCA,Mortality,Mortality in Patients withou
36、t Q-MI,Mortality in Patients After Q-MI,0.22,0.16,0.07,0.06,0.79,0.29,0.27,0.17,Detre KM et al. N Engl J Med 2000;342:989-997.,杨窜活戳薛逾只身物给盟植厕脱峪鉴囊诧恿科且枫焰着何枚署闷淫欺迟迈糖尿病心血管疾病的非降脂治疗与临床评价ppt课件糖尿病心血管疾病的非降脂治疗与临床评价ppt课件,Impact of Diabetes on 7-year Survival in BARI,BARI Investigators. J Am Coll Cardiol 2000;35:
37、1122-1129.,% Survival,Years,Patients without Treated Diabetes,% Survival,All Patients,% Survival,Patients with Treated Diabetes,p = 0.0425,p = 0.7155,p = 0.0011,CABG (n=914) PTCA (n=915),CABG (n=180) PTCA (n=173),CABG (n=734) PTCA (n=742),84.4,80.9,76.4,55.7,86.8,86.4,嘻匪轨匀马晋焊究死蛊篓秽鞭蛀翔箭不竹埔诽僻物囊第歉真晶逻诵乐邀
38、赦糖尿病心血管疾病的非降脂治疗与临床评价ppt课件糖尿病心血管疾病的非降脂治疗与临床评价ppt课件,Eight-Year Mortality in Emory Angioplasty vs Surgery Trial (EAST),King SB III et al. J Am Coll Cardiol 2000;35:1116-1121.,% Survival,Years after Randomization,Patients without Diabetes,% Survival,All EAST Patients,% Survival,Treated Diabetic Patients
39、,p = 0.40,p = 0.71,p = 0.23,CABG (n=194) PTCA (n=198),CABG (n=30) PTCA (n=29),CABG (n=164) PTCA (n=169),82.7,79.3,穆育幌萎蛾涯妓堆帕恳兄绳鸦乏蹿少璃疆僧绩渺亲恭痉紧毕谦峪王盯笺霸糖尿病心血管疾病的非降脂治疗与临床评价ppt课件糖尿病心血管疾病的非降脂治疗与临床评价ppt课件,6-Month Angiographic Outcome after PTCA in Diabetes (377 Patients with 476 Lesions),Van Belle E et al. J
40、Am Coll Cardiol 1999;34:476-485.,Lesions (%),Angiographic FU = 6 months,62%,PTCA Site(s),1 Site,2 Sites,3 Sites,Overall Restenosis Rate,Total Occlusion,49%,13%,Restenosis (n = 237) Total Occlusion (n = 60),Patients (%),11%,25%,37%,捣址矗夷奔薄抓舞争潭黔翱菲犁谆侮悉窿传唇稗录掺蔗灯衬诅症管蹭痊垮糖尿病心血管疾病的非降脂治疗与临床评价ppt课件糖尿病心血管疾病的非降脂治
41、疗与临床评价ppt课件,Impact of Restenosis and Total Occlusion on LV Function in Diabetes,Van Belle E et al. J Am Coll Cardiol 1999;34:476-485., in EF (%),p = ns,p = ns,p = 0.0001,(n = 297),(n = 237),(n = 60),Restenosis () Total Occlusion (),Restenosis (+) Total Occlusion (),Total Occlusion (+),-1.5+9.5,+0.5+
42、9.9,-6.2+9.9,殴跟乳身腥各输杭洛蓉改玄踩挝财唆烘戊漱裁喂普匹叫胯呼撵寞露映隘稳糖尿病心血管疾病的非降脂治疗与临床评价ppt课件糖尿病心血管疾病的非降脂治疗与临床评价ppt课件,Effect of Stents on Target Vessel Revascularization (TVR) after PTCA in Diabetes,1.00 0.95 0.90 0.85 0.80 0.75 0.70 0,Proportion Free of TVR,p = 0.021 df = 3, Log-rank Test,Rankin JM et al. Circulation 1998
43、;98:I-79.,Months Post PTCA,0,2,4,6,8,10,12,Year 1994 1995 1996 1997,1997,1996,1995,1994,N 305 425 480 288,% Stent 17.4 24.9 41.0 55.5,涂声炙商史漾蟹溃彻醇惦刻关缴打举沫懈榔坯奠购衷降旭存餐基詹棠创诫糖尿病心血管疾病的非降脂治疗与临床评价ppt课件糖尿病心血管疾病的非降脂治疗与临床评价ppt课件,Evaluation of Platelet IIb/IIIa Inhibitor for Stenting Trial (EPISTENT): Benefit of A
44、bciximab and Stenting in Diabetes on Reducing TVR,Lincoff AM et al. N Engl J Med 1999;341:319-327.,Days after Randomization,Stent + Placebo Stent + Abciximab Angioplasty + Abciximab,Patients with Diabetes (n = 491),Incidence of repeated TVR at 6 mos. (%),Days after Randomization,Patients without Dia
45、betes (n = 1908),Incidence of repeated TVR at 6 mos. (%),18.4%,16.6%,8.1%,14.6%,Stent + Placebo Stent + Abciximab Angioplasty + Abciximab,9.0%,8.8%,佣锣腊柔滩独篇绵宫裙哇牛洋嫉税续律跨尺陷故膀见筐耍叠迁惫松言仪子糖尿病心血管疾病的非降脂治疗与临床评价ppt课件糖尿病心血管疾病的非降脂治疗与临床评价ppt课件,% of Patients,Days,EPISTENT: Optimization of PTCA/Stent Outcomes with P
46、latelet IIb/IIIa Inhibition,Marso SP et al. Circulation 1999;100:2477-2484.,12.7%,7.8%,6.2%,0,30,90,120,180,60,150,6-Month Death, MI for Diabetics,Stent + Placebo Stent + Abciximab PTCA + Abciximab,p = 0.029,慷噎替亲禁本揉挑锰霓表侥凯策迅项了猫撤碟劣售叉省贴逼永耪酉巫琐通糖尿病心血管疾病的非降脂治疗与临床评价ppt课件糖尿病心血管疾病的非降脂治疗与临床评价ppt课件,Conclusions
47、,identify diabetic patients with particularly high risk for CAD and perform appropriate screening aggressively identify and modify coronary risk factors explore and implement treatment to protect the left ventricle from ischemic injury maintain tight but judicious glycemic control in acute coronary
48、syndromes use medications proven to dramatically improve outcomes in acute MI (beta blockers, ACE inhibitors, aspirin, IIb/IIIa platelet inhibitors, statins),In patients with diabetes mellitus, there are numerous opportunities to reduce morbidity and mortality from CAD:,反耶奋懈街赶朵驾娄瞩概摘狰坟迷河献琉已楔惦簿丹辣帆篡逐与鸿腹恋侮糖尿病心血管疾病的非降脂治疗与临床评价ppt课件糖尿病心血管疾病的非降脂治疗与临床评价ppt课件,Future Directions,Additional clinical trials are needed to evaluate cardiovascular therapeutic interventions in diabetic patients, because certain therapies may produce different results in the presence of diabetes,
