Purpose of Review

What is new? Cardiovascular disease (CVD) is the leading cause of mortality in type 2 diabetes (T2D) individuals. Of the major risk factors for CVD, less than 10% of T2D people meet the American Diabetes Association/American Heart Association recommended goals of therapy. The present review examines how much of the absolute cardiovascular (CV) risk in type 2 diabetes patients can be explained by major CV intervention trials.

Recent Findings

Multiple long-term cardiovascular (CV) intervention trials have examined the effect of specific target-directed therapies on the MACE endpoint. Only one prospective study, STENO-2, has employed a multifactorial intervention comparing intensified versus conventional treatment of modifiable risk factors in T2D patients, and demonstrated a 20% absolute CV risk reduction.

Summary

If the absolute CV risk reduction in these trials is added to that in the only prospective multifactorial intervention trial (STENO-2), the unexplained CV risk is 44.1%.

What are the clinical implications?

• Potential explanations for the unaccounted-for reduction in absolute CV risk in type 2 diabetes (T2D) patients are discussed.

• Hypothesis: failure to take into account synergistic interactions between major cardiovascular risk factors is responsible for the unexplained CV risk in T2D patients.

• Simultaneous treatment of all major CV risk factors to recommended AHA/ADA guideline goals is required to achieve the maximum reduction in CV risk.

中文翻译：

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2 型糖尿病中无法解释的残留风险：问题有多大？

审查目的

有什么新内容？心血管疾病 (CVD) 是 2 型糖尿病 (T2D) 个体死亡的主要原因。在 CVD 的主要危险因素中，只有不到 10% 的 T2D 患者达到美国糖尿病协会/美国心脏协会推荐的治疗目标。本综述探讨了 2 型糖尿病患者的绝对心血管 (CV) 风险在多大程度上可以通过主要的 CV 干预试验来解释。

最近的发现

多项长期心血管 (CV) 干预试验研究了特定靶向治疗对 MACE 终点的影响。只有一项前瞻性研究 STENO-2 采用多因素干预措施，比较了 T2D 患者可改变危险因素的强化治疗与常规治疗，并证明绝对 CV 风险降低了 20%。

概括

如果将这些试验中的绝对 CV 风险降低添加到唯一的前瞻性多因素干预试验 (STENO-2) 中，则不明原因的 CV 风险为 44.1%。

有什么临床意义？

• 讨论了 2 型糖尿病 (T2D) 患者绝对心血管风险不明原因降低的潜在解释。

• 假设：未能考虑主要心血管危险因素之间的协同相互作用是导致 T2D 患者出现无法解释的心血管风险的原因。

• 需要根据推荐的 AHA/ADA 指南目标同时治疗所有主要 CV 风险因素，以最大限度地降低 CV 风险。