<International Circulation>:  Given the increasing prevalence and substantial concomitant risk for CVD， diabetes mellitus can no longer be perceived as just an endocrine disorder. What is the current best course of action for dealing with hyperglycemia in cardiovascular disease patients?

    《国际循环》：考虑到糖尿病给日益增多的心血管疾病带来的伴发风险，它不能再单纯认为是一种内分泌疾病。您认为目前解决心血管疾病患者的高血糖问题，最有效的措施是什么？

　　Professor Ray:  If you look at the observational data， it would suggest that having diabetes doubles your risk of vascular disease which doesn’t have to be coronary， it could be cerebrovascular. And unlike lipids: high total cholesterol or LDL-C for example， it also increases the risk for hemorrhagic stroke. This is a disease basically affecting the vasculature and it gets worse with duration of diabetes.  If you take conventional risk factors into account， you don’t actually get rid of the risk from  diabetes so prevention of diabetes becomes that much more important. So the first approach would be working on prevention with diet， lifestyle and exercise. Programs such as the US Diabetes Prevention Program and the Finnish Diabetes Prevention Study become important. In individuals with diabetes， the two most powerful interventions you have for lowering cardiovascular risk are: blood pressure reduction， because for every 4 mmHg lower systolic blood pressure you reduce about 12 ½ events per 1000 people you treat per year; and you reduce about 8 ½ events for every 39mg/dl reduction in LDL cholesterol. If you lower HbA1c by 0.9%， you prevent about three events.  So HbA1c lowering is a weaker intervention but if you combine all of these together over a longer period of time you actually see a mortality benefit as we know from the STENO-2 trial. All of these things are independent but if you were to prioritize you would prioritize blood pressure reduction and you would prioritize lipid lowering but you should probably offer better glycemic control as well. We know there are certainly benefits on the microvasculature and at least from the meta-analysis that we did， there are also coronary benefits as well.

    Ray教授:观察性研究的数据表明，糖尿病会使血管疾病的风险增加一倍，不仅是冠状动脉，也可能是脑血管，其它如血脂、总胆固醇、LDL-C等升高也会增加出血性卒中的风险。糖尿病是一种主要影响脉管系统的疾病，患病时间的延长，影响也越大。如果将常见的风险因素考虑在内，患糖尿病的风险是无法摆脱的，所以预防就变得越来越重要。预防中的首要措施是注意饮食，改善生活方式和加强锻炼。美国糖尿病预防计划（US Diabetes Prevention Program）和糖尿病预防研究（Finnish Diabetes Prevention Study）等糖尿预防项目也非常重要。糖尿病患者降低心血管风险最有效的2个干预措施是降低血压和降低血脂。因为收缩压每降低4 mmHg，治疗人群的心血管事件就减少12.5/1000例患者；而LDL-C每降低39 mg/dl，心血管事件减少8.5/1000例患者。HbA1c每降低0.9%，心血管事件减少3/1000例患者。所以相比之下，降低HbA1c是一种效果较差的干预措施。但是如果持续地综合采取这些措施，就能降低死亡率，正如我们在STENO-2中看到的那样。 这些因素彼此之间都是独立的，但以优先考虑而言，应该优先考虑降低血压和血脂，此外，还要更好地控制血糖。当然，微脉管系统也会从这些措施中获益，至少荟萃分析的结果是这样的，冠状动脉也同样能从中获益。

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