[欧洲心脏病学会关于糖尿病患者心血管疾病管理的 2023 年临床指南摘要]。

A D Erlikh, A V Zilov, D Y Shchekochikhin, S B Shornikov, E V Bublik, O I Vinogradskaya, A I Grishkovets, A G Farmanov, E G Ryzhkova
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摘要

心血管疾病(CVDs)的发病率众所周知。据世界卫生组织(WHO)统计,全世界每年有近 1800 万人死于心血管疾病,占所有死亡原因的 31%[1]。心血管疾病通常与糖尿病(DM)同时发生,约 20% 的心血管疾病死亡归因于血糖水平升高[2]。值得注意的是,心血管疾病是 2 型糖尿病(T2DM)患者的主要死因。动脉粥样硬化性心血管疾病与糖尿病之间的病理生理学相互作用导致心脏病专家越来越多地参与糖尿病患者的治疗,而内分泌专家则遇到越来越多的心血管疾病患者。这种关联已经变得如此明显,以至于在最近发表于《欧洲心脏病学杂志》的一篇文章中,Yu.Braunwald 在最近发表在《欧洲心脏病学杂志》上的一篇文章中推测,将出现一个新的亚专科--糖尿病心脏病学[4]。最近有关某些降糖药物(主要是某些 SGLT2 抑制剂、几种 GLP-1 受体激动剂和一种新型非甾体类矿化皮质激素受体拮抗剂非格列酮)对心血管疾病的益处的数据证明,有必要采用统一的跨学科方法来管理心血管疾病和糖尿病。鉴于综合协调管理心血管疾病和糖尿病患者的重要性,欧洲心脏病学会(ESC)特别工作组于 2023 年更新、制定并发布了糖尿病患者心血管疾病治疗的临床指南[6]。本文简要概述了指南中的主要规定。
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[Summary of the 2023 European Society of Cardiology clinical guidelines on the management of cardiovascular disease in patients with diabetes mellitus].

The prevalence of cardiovascular diseases (CVDs) is well known. According to the World Health Organization (WHO), almost 18 million people die from CVDs worldwide every year, accounting for 31% of all causes of death [1]. CVDs often develop concomitantly with diabetes mellitus (DM), with approximately 20% of cardiovascular deaths attributed to elevated blood glucose levels [2]. Notably, CVDs are the leading cause of death among patients with type 2 diabetes (T2DM). Based on data from the Federal Register of Diabetes 2022 in Russia, chronic heart failure was the direct cause of death in 24.2% of T2DM cases, followed by acute heart failure (13.1%), cerebrovascular events (10.0%), and myocardial infarction (3.7%) [3].The pathophysiological interplay between atherosclerotic cardiovascular disease and DM has led to a situation where cardiologists are increasingly involved in the treatment of patients with DM, while endocrinologists are encountering a growing number of patients with CVDs. This association has become so apparent that in a recent article published in the European Journal of Cardiology, Yu. Braunwald speculated about the emergence of a new subspecialty - diabetocardiology [4]. Unfortunately, experts predict that the global number of diabetic patients will reach 783 million [5].Recent data on the CV benefits of certain hypoglycemic drugs (primarily, certain SGLT2 inhibitors, several GLP-1 receptor agonists, and a novel non-steroidal mineralocorticoid receptor antagonist finerenone) prove the need for a unified interdisciplinary approach to managing CVDs and DM.Given the importance of integrated and coordinated efforts in managing patients with CVD and DM, the Task Force of the -European Society of Cardiology (ESC) updated, formulated, and published clinical guidelines on the treatment of CVD in diabetic patients in 2023 [6]. This article provides a concise overview of the key provisions outlined in the guidelines.

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