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糖尿病、糖尿病前期和心血管疾病指南(ESC&EASD)

 

糖尿病、糖尿病前期和心血管疾病指南(ESC&EASD)

Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary

The Task Force on Diabetes and Cardiovascular Diseases

of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD)

 
Table of Contents
Preamble
Introduction
Definition, classification, and screening of diabetes and pre-diabetic glucose abnormalities 
Epidemiology of diabetes, IGH, and cardiovascular risk 
Identification of subjects at high risk for cardiovascular disease or diabetes
Treatment to reduce cardiovascular risk
Management of cardiovascular disease 
Heart failure and diabetes 
Arrhythmias: atrial fibrillation and sudden cardiac death 
Peripheral and cerebrovascular disease 
Intensive care
Health economics and diabetes 
References 
 
Preamble
     Guidelines and Expert Consensus documents aim to present management and recommendations based on all of the relevant evidence on a particular subject in order to help physicians to select the best possible management strategies for the individual patient, suffering from a specific condition, taking into account not only the impact on outcome, but also the risk benefit ratio of a particular diagnostic or therapeutic procedure. The ESC recommendations for guidelines production can be found on the ESC websitet.
 
     In brief, the ESC appoints experts in the field to carry out a comprehensive and critical evaluation of the use of diagnostic and therapeutic procedures and to assess the risk–benefit ratio of the therapies recommended for management and/or prevention of a given condition. The strength of evidence for or against particular procedures or treatments isweighed according to predefined scales for grading recommendations and levels of evidence, as outlined below. Once the document has been finalized and approved by all the experts involved in the Task Force, it is submitted to outside specialists for
review. If necessary, the document is revised once more to be finally approved by the Committee for Practice Guidelines and selected members of the Board of the ESC.
 
     The ESC Committee for Practice Guidelines (CPG) supervises and coordinates the preparation of new Guidelines and Expert Consensus Documents produced by Task Forces, expert groups, or consensus panels. The chosen experts in these writing panels are asked to provide disclosure statements of all relationships they may have, which might be perceived as real or potential conflicts of interest. These disclosure forms are kept on file at the European Heart House, headquarters of the ESC. The Committee is also responsible for the endorsement of these Guidelines and Expert Consensus Documents or statements.
 
Introduction

      Diabetes and cardiovascular diseases (CVD) often appear astwo sides of a coin: diabetes mellitus (DM) has been ratedas an equivalent of coronary heart disease, and conversely,many patients with established coronary heart diseasesuffer from diabetes or its pre-states. Thus, it is hightime that diabetologists and cardiologists join their forcesto improve the quality management in diagnosis and carefor the millions of patients who have both cardiovascularand metabolic diseases in common. The cardiodiabetologicalapproach not only is of utmost importancefor the sake of those patients, but also instrumental forfurther progress in the fields of cardiology and diabetologyand prevention.

 

     The ESC and the EASD accepted this challenge and havedeveloped joint, evidence-based guidelines for diabetesand CVD. Experts from both sides were asked to form aTask Force. The core approach of the group is depicted inFigure 1. An algorithm was developed to help discover CVDin patients with diabetes, and vice versa, the metabolic diseasesin patients with coronary heart disease, setting thebasis for appropriate joint therapy.

 
     This executive summary, an abridged version of the fulldocument, is intended for the practising physician. Itfocuses on the background and the most relevant referencesbehind the given recommendations. More detailed informationis to be found in the full text document. Thenumbering of references is the same in the executivesummary as in this document. Figures and tables are,however, numbered in numerical order in the executivesummary and do therefore not necessarily have the samenumbers in the full-text document. The latter also containsa detailed chapter on the pathophysiological connectionsbetween glucose abnormalities and CVD and much moreinformation on the economical aspects on diabetesand CVD. The full text guidelines will be available fromthe ESC/EASD web pages (www.escardio.org and www.easd.org).
 
      It is a privilege for the co-chairmen having been able towork with the best reputed experts in the field and to givethese guidelines now to the community of cardiologistsand diabetologists. We wish to thank all members of thetask force, who so generously shared their knowledge, aswell as the referees for their tremendous input. Specialthanks go to Professor Carl Erik Mogensen for his advice onthe diabetic renal disease and microalbuminuria sections.We would also like to thank the ESC and the EASD formaking these guidelines possible. Finally, we want toexpress our appreciation of the guideline team at theHeart House, especially Veronica Dean, for extremelyhelpful support.
 
     Stockholm and Munich September 2006
     Professor Lars Ryde′n, Past-President ESC
     Professor Eberhard Standl, Vice President EASD

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