“为什么糖尿病中有更多心血管疾病?”Daniel L. Lorber，实用糖尿病学，2006年12月。

我们喜欢实用糖尿病学，因为它直接、可行、聪明——但要注意，它是为医生准备的。这篇文章探讨了糖尿病与心血管疾病的关系。心血管疾病指的是心脏、静脉或动脉的问题，包括中风和心脏病发作等不良事件。最近，它与糖尿病的关系得到了广泛的承认。这种关系的细节还不完全清楚，但我们知道，四分之三的糖尿病相关死亡与心血管疾病有关。我们知道，虽然美国心脏病的发病率总体上下降了25%，但女性糖尿病患者的发病率却上升了23%。毫无疑问，糖尿病会损害血管。“血管内皮”指的是我们血管的内壁，洛伯医生告诉我们，血管内皮本身就像一个活跃的器官，而不是一个被动的内壁。换句话说，通过荷尔蒙和分泌物，它确实有作用。它能有效地抑制凝血，不规则生长和痉挛性收缩。 A diseased endothelium doesn't just seem not to do these things, but it seems to do the opposite, encouraging clots, spasms, and so on. Though it is sometimes hard to separate the chronic hyperglycemia of diabetes with the other risk factors in type 2 diabetes (like unhealthy lipids or high blood pressure), it appears that hyperglycemia itself actually diminishes the vascular endothelium's ability to do its job. A very large and famous trial in diabetes, the Diabetes Control and Complications Trial (DCCT), showed that early control of hyperglycemia in people with type 1 produced a 42% reduction in cardiovascular events in the long term. Also, there is a five-fold increased risk for cardiovascular disease between ages 20 and 39 in people with type 1 relative to the non-diabetic population. Since people with type 1 don't necessarily have the classic risk factors, both statistics support the idea that hyperglycemia itself is bad for the vascular system. Dr. Lorber also discusses the relationship of hypertension (or high blood pressure), dyslipidemia (more "bad" cholesterol and less "good" cholesterol), and inflammation (a hot research area), with cardiovascular risk. Risk factors seem to be synergistic, meaning the risk of having two is more than the risk of having one plus the risk of having the other. But this article isn't just bad news — it's a call to doctors (and you!) to be vigilant about heart disease, not only by controlling glycemia but also by looking out carefully for other risk factors.

底线:长期高血糖似乎对血管有害，而血管是预防心脏病的活性器官。不仅要控制血糖以降低患心脏病的风险，而且每个有葡萄糖不耐受(1型、2型或前期糖尿病患者)的人都应该警惕其他心血管危险因素，如高血压和胆固醇水平低。