糖尿病与动脉粥样硬化PPT优选课件

Decreased HDL
12% 21%
Increased triglycerides 9% 19%
WOMEN
Normal DM 21% 24%
16% 15%
10% 25%
8% 17%
Garg A et al. Diabetes Care 1990;13:153-169.
Mean Plasma Lipids at Diagnosis of Type 2 Diabetes - UKPDS
Hyperinsulinemia Diabetes
Hypertriglyceridemia Small, dense LDL Low HDL Hypercoagulability
Atherosclerosis
Insulin Resistance and Hyperinsulinemia: Clinical Clues
625 r = 0.73 P < 0.0001
500
400
300
200
100 100 200 300 400 500 600
Insulin Response to Oral Glucose*
* Total area under 3-hour response curve (mean of 2 tests). Olefsky JM et al. Am J Med. 1974;57:551-560.
Number of Pts TC (mg/dl) LDL-C (mg/dl) HDL-C (mg/dl) TG (mg/dl)
MEN
Type 2 Control
2139
52
213
205
139
132
39** 43
159*
103
WOMEN
Type 2 Control
1574
143
224
217
151* 135
Association Between Hyperinsulinemia and Low HDL-C
60
P<0.005 50
Hyperinsulinemic Normoinsulinemic P<0.005
40
HDL-C (mg/dL)
30
20 Nonobese
Reaven GM. In: LeRoith D et al., eds. Diabetes Mellitus. Philadelphia: Lippincott-Raven,1996:509-519.
TG
CE (CETP) TG
Apo A-1
Kidney
LDL
SD LDL
(lipoprotein or hepatic lipase)
Dyslipidemia in Diabetes
Increased
Triglycerides
VLDL
LDL and small dense LDL
Apo B
TG Apo A-1
Insulin
Kidney
Mechanisms Relating Insulin Resistance and Dyslipidemia
Fat Cells
Liver
FFA
CE
IR X
Insulin
TG Apo B
VLDL (CETP)
HDL
(hepatic lipase)
VLDL
Diabetic Dyslipidemia and Atherosclerosis
Henry Ginsberg, MD
Interrelation Between Atherosclerosis and Insulin Resistance
Insulin Resistance
Hypertension Obesity
Liver
FFA
IR X
TG Apo B VLDL
VLDL
Insulin
Mechanisms Relating Insulin Resistance and Dyslipidemia
Fat Cells
Liver
FFA
CE
Biblioteka Baidu
IR X
TG Apo B VLDL
VLDL (CETP)
HDL
(hepatic lipase)
51
87
47
29
24
54
34
30
36
543
85
9
6
* Feingold KR et al. Arterioscler Thromb 1992; 12:1496-1502. ** Selby JV et al. Circulation 1993; 88:381-387.
43*
55
159*
95
* P<0.001, ** P<0.02 comparing type 2 vs. controll UKPDS Group. Diabetes Care 1997;20:1683-1687.
Plasma TG (mg/dL)
Relation Between Insulin Resistance and Hypertriglyceridemia
Abdominal obesity TG + HDL-C Glucose intolerance Hypertension Atherosclerosis Ethnicity
Dyslipidemia in the Insulin Resistance Syndrome Elevated total TG
Reduced HDL-C
Small, dense LDL-C
Dyslipidemias in Adults with Diabetes Framingham Heart Study
Increased cholesterol
MEN
Normal DM
14% 13%
Increased LDL
11% 9%
Obese
Mechanisms Relating Insulin Resistance and Dyslipidemia
Fat Cells
Liver
FFA
IR X
Insulin
Mechanisms Relating Insulin Resistance and Dyslipidemia
Fat Cells
Decreased
HDL Apo A-I
LDL Subclass Phenotypes in Diabetes Mellitus
Men* Diabetic Nondiabetic
Women** Diabetic Nondiabetic
LDL Subclass
n
A
Int
B
Percent
29
28
21