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Endothelial Dysfunction in Diabetes: Pathogenesis, Significance, and Treatment

机译:糖尿病内皮功能障碍:发病机制,意义和治疗。

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Type 2 diabetes (T2D) markedly increases the risk of cardiovascular disease. Endothelial dysfunction (ED), an early indicator of diabetic vascular disease, is common in T2D and independently predicts cardiovascular risk. Although the precise pathogenic mechanisms for ED in T2D remain unclear, at inception they probably involve uncoupling of both endothelial nitric oxide synthase activity and mitochondrial oxidative phosphorylation, as well as the activation of vascular nicotinamide adenine dinucleotide phosphate oxidase. The major contributing factors include dyslipoproteinemia, oxidative stress, and inflammation. Therapeutic interventions are designed to target these pathophysiological factors that underlie ED. Therapeutic interventions, including lifestyle changes, antiglycemic agents and lipid-regulating therapies, aim to correct hyperglycemia and atherogenic dyslipidemia and to improve ED. However, high residual cardiovascular risk is seen in both research and clinical practice settings. Well-designed studies of endothelial function in appropriately selected volunteers afford a good opportunity to test new therapeutic interventions, paving the way for clinical trials and utilization in the care of the diabetic patient. However, based on the results from a recent clinical trial, niacin should not be added to a statin in individuals with low high-density lipoprotein cholesterol and very well controlled low-density lipoprotein cholesterol.
机译:2型糖尿病(T2D)明显增加了患心血管疾病的风险。血管内皮功能障碍(ED)是糖尿病血管疾病的早期指标,在T2D中很常见,并且可以独立预测心血管疾病的风险。尽管尚不清楚ED在T2D中的确切致病机制,但从一开始它们就可能涉及内皮一氧化氮合酶活性与线粒体氧化磷酸化以及血管烟酰胺腺嘌呤二核苷酸磷酸氧化酶的激活之间的脱钩。主要的影响因素包括血脂异常,氧化应激和炎症。治疗性干预旨在针对ED的这些病理生理因素。治疗干预措施包括改变生活方式,降糖药和调脂治疗,旨在纠正高血糖症和动脉粥样硬化性血脂异常,并改善ED。然而,在研究和临床实践中均发现高残留心血管风险。在适当选择志愿者内皮功能精心设计的研究提供了良好的机会来测试新的治疗干预措施,从而为在护理糖尿病患者的临床试验和利用的方式。但是,根据最近的一项临床试验结果,对于高密度脂蛋白胆固醇低且控制性很好的低密度脂蛋白胆固醇的个体,烟酸不应添加到他汀类药物中。

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