Diabetes affects every organ in the body and cardiovascular disease accounts for two-thirds of the mortality in the diabetic population.Diabetes-related heart disease occurs in the form of coronary artery disease(CAD)...Diabetes affects every organ in the body and cardiovascular disease accounts for two-thirds of the mortality in the diabetic population.Diabetes-related heart disease occurs in the form of coronary artery disease(CAD),cardiac autonomic neuropathy or diabetic cardiomyopathy(DbCM).The prevalence of cardiac failure is high in the diabetic population and DbCM is a common but underestimated cause of heart failure in diabetes.The pathogenesis of diabetic cardiomyopathy is yet to be clearly defined.Hyperglycemia,dyslipidemia and inflammation are thought to play key roles in the generation of reactive oxygen or nitrogen species which are in turn implicated.The myocardial interstitium undergoes alterations resulting in abnormal contractile function noted in DbCM.In the early stages of the disease diastolic dysfunction is the only abnormality,but systolic dysfunction supervenes in the later stages with impaired left ventricular ejection fraction.Transmitral Doppler echocardiography is usually used to assess diastolic dysfunction,but tissue Doppler Imaging and Cardiac Magnetic Resonance Imaging are being increasingly used recently for early detection of DbCM.The management of DbCM involves improvement in lifestyle,control of glucose and lipid abnormalities,and treatment of hypertension and CAD,if present.The role of vasoactive drugs and antioxidants is being explored.This review discusses the pathophysiology,diagnostic evaluation and management options of DbCM.展开更多
Cardiac autonomic neuropathy(CAN)is an often overlooked and common complication of diabetes mellitus.CAN is associated with increased cardiovascular morbidity and mortality.The pathogenesis of CAN is complex and invol...Cardiac autonomic neuropathy(CAN)is an often overlooked and common complication of diabetes mellitus.CAN is associated with increased cardiovascular morbidity and mortality.The pathogenesis of CAN is complex and involves a cascade of pathways activated by hyperglycaemia resulting in neuronal ischaemia and cellular death.In addition,autoimmune and genetic factors are involved in the development of CAN.CAN might be subclinical for several years until the patient develops resting tachycardia,exercise intolerance,postural hypotension,cardiac dysfunction and diabetic cardiomyopathy.During its sub-clinical phase,heart rate variability that is influenced by the balance between parasympathetic and sympathetic tones can help in detecting CAN before the disease is symptomatic.Newer imaging techniques(such as scintigraphy)have allowed earlier detection of CAN in the pre-clinical phase and allowed better assessment of the sympathetic nervous system.One of the main difficulties in CAN research is the lack of a universally accepted definition of CAN;however,the Toronto Consensus Panel on Diabetic Neuropathy has recently issued guidance for the diagnosis and staging of CAN,and also proposed screening for CAN in patients with diabetes mellitus.A major challenge,however,is the lack of specific treatment to slow the progression or prevent the development of CAN.Lifestyle changes,improved metabolic control might prevent or slow the progression of CAN.Reversal will require combination of these treatments with new targeted therapeutic approaches.The aim of this article is to review the latest evidence regarding the epidemiology,pathogenesis,manifestations,diagnosis and treatment for CAN.展开更多
目的观察益气养阴活血方对早期糖尿病心肌病患者的临床疗效。方法将80例早期糖尿病心肌病患者随机分为对照组和治疗组,每组40例。两组均采取基础降糖治疗,对照组口服阿托伐他汀钙片;治疗组在对照组的基础上加用益气养阴活血方治疗。两...目的观察益气养阴活血方对早期糖尿病心肌病患者的临床疗效。方法将80例早期糖尿病心肌病患者随机分为对照组和治疗组,每组40例。两组均采取基础降糖治疗,对照组口服阿托伐他汀钙片;治疗组在对照组的基础上加用益气养阴活血方治疗。两组均治疗12周。观察两组患者治疗前后空腹血糖(fasting blood glucose,FBG)、糖化血红蛋白A1c(glycosylated hemoglobin A1c,HbA1c)、TC、TG、LDL-C、HDL-C、餐后2 h血糖(2 h postprandial blood glucose,2 h PG)、左室射血分数(left ventricular ejection fraction,LVEF)、E峰/A峰比值(E/A)及中医证候疗效变化情况。结果与本组治疗前比较,治疗后两组FBG、2 h PG、HbA1c、TC、TG、LDL-C均降低(P<0.05),治疗组HDL-C升高(P<0.05),两组LVEF、E/A值均提高(P<0.05);与对照组比较,治疗组治疗后FBG、2 h PG、HbA1c、TC、TG、LDL-C均明显降低,HDL-C升高,LVEF、E/A值升高明显,差异均有统计学意义(P<0.05)。治疗组中医证候疗效为90.0%(36/40),优于对照组[67.5%(27/40)],差异有统计学意义(χ~2=4.781,P=0.028)。结论益气养阴活血方在早期糖尿病心肌病的治疗方面,具有辅助降糖、协同调脂、改善心室舒张功能、改善中医证候疗效的作用。展开更多
文摘Diabetes affects every organ in the body and cardiovascular disease accounts for two-thirds of the mortality in the diabetic population.Diabetes-related heart disease occurs in the form of coronary artery disease(CAD),cardiac autonomic neuropathy or diabetic cardiomyopathy(DbCM).The prevalence of cardiac failure is high in the diabetic population and DbCM is a common but underestimated cause of heart failure in diabetes.The pathogenesis of diabetic cardiomyopathy is yet to be clearly defined.Hyperglycemia,dyslipidemia and inflammation are thought to play key roles in the generation of reactive oxygen or nitrogen species which are in turn implicated.The myocardial interstitium undergoes alterations resulting in abnormal contractile function noted in DbCM.In the early stages of the disease diastolic dysfunction is the only abnormality,but systolic dysfunction supervenes in the later stages with impaired left ventricular ejection fraction.Transmitral Doppler echocardiography is usually used to assess diastolic dysfunction,but tissue Doppler Imaging and Cardiac Magnetic Resonance Imaging are being increasingly used recently for early detection of DbCM.The management of DbCM involves improvement in lifestyle,control of glucose and lipid abnormalities,and treatment of hypertension and CAD,if present.The role of vasoactive drugs and antioxidants is being explored.This review discusses the pathophysiology,diagnostic evaluation and management options of DbCM.
文摘Cardiac autonomic neuropathy(CAN)is an often overlooked and common complication of diabetes mellitus.CAN is associated with increased cardiovascular morbidity and mortality.The pathogenesis of CAN is complex and involves a cascade of pathways activated by hyperglycaemia resulting in neuronal ischaemia and cellular death.In addition,autoimmune and genetic factors are involved in the development of CAN.CAN might be subclinical for several years until the patient develops resting tachycardia,exercise intolerance,postural hypotension,cardiac dysfunction and diabetic cardiomyopathy.During its sub-clinical phase,heart rate variability that is influenced by the balance between parasympathetic and sympathetic tones can help in detecting CAN before the disease is symptomatic.Newer imaging techniques(such as scintigraphy)have allowed earlier detection of CAN in the pre-clinical phase and allowed better assessment of the sympathetic nervous system.One of the main difficulties in CAN research is the lack of a universally accepted definition of CAN;however,the Toronto Consensus Panel on Diabetic Neuropathy has recently issued guidance for the diagnosis and staging of CAN,and also proposed screening for CAN in patients with diabetes mellitus.A major challenge,however,is the lack of specific treatment to slow the progression or prevent the development of CAN.Lifestyle changes,improved metabolic control might prevent or slow the progression of CAN.Reversal will require combination of these treatments with new targeted therapeutic approaches.The aim of this article is to review the latest evidence regarding the epidemiology,pathogenesis,manifestations,diagnosis and treatment for CAN.
文摘目的观察益气养阴活血方对早期糖尿病心肌病患者的临床疗效。方法将80例早期糖尿病心肌病患者随机分为对照组和治疗组,每组40例。两组均采取基础降糖治疗,对照组口服阿托伐他汀钙片;治疗组在对照组的基础上加用益气养阴活血方治疗。两组均治疗12周。观察两组患者治疗前后空腹血糖(fasting blood glucose,FBG)、糖化血红蛋白A1c(glycosylated hemoglobin A1c,HbA1c)、TC、TG、LDL-C、HDL-C、餐后2 h血糖(2 h postprandial blood glucose,2 h PG)、左室射血分数(left ventricular ejection fraction,LVEF)、E峰/A峰比值(E/A)及中医证候疗效变化情况。结果与本组治疗前比较,治疗后两组FBG、2 h PG、HbA1c、TC、TG、LDL-C均降低(P<0.05),治疗组HDL-C升高(P<0.05),两组LVEF、E/A值均提高(P<0.05);与对照组比较,治疗组治疗后FBG、2 h PG、HbA1c、TC、TG、LDL-C均明显降低,HDL-C升高,LVEF、E/A值升高明显,差异均有统计学意义(P<0.05)。治疗组中医证候疗效为90.0%(36/40),优于对照组[67.5%(27/40)],差异有统计学意义(χ~2=4.781,P=0.028)。结论益气养阴活血方在早期糖尿病心肌病的治疗方面,具有辅助降糖、协同调脂、改善心室舒张功能、改善中医证候疗效的作用。
