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Diabetic cardiovascular disease

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  • 概述
  • 理论
  • 诊断
  • 治疗
  • 随访
  • 资源
最后审阅： 6 Nov 2025
最后更新： 25 Sep 2025

小结

定义

病史和体格检查

关键诊断因素

  • chest pain
  • dyspnea on exertion
  • hypotension
  • rales
  • S3 gallop
  • hypertension
  • nausea
  • diaphoresis
  • tachycardia
  • indigestion
完整详情

其他诊断因素

  • unilateral weakness, numbness, and/or tingling
  • headache
  • intermittent claudication
  • bruits
  • aphasia
  • hemisensory loss
  • cranial nerve palsies
  • seizures
  • vertigo
  • limb pain at rest
  • diminished/absent lower extremity pulses
  • ulcers or gangrene
  • peripheral edema
  • smooth shiny skin with hair loss
  • pallor
完整详情

危险因素

  • cigarette smoking
  • hypertension
  • dyslipidemia
  • poor glycemic control
  • physical inactivity
  • overweight and obesity
  • albuminuria
  • chronic kidney disease (CKD)
  • elevated C-reactive protein
  • family history of CVD
  • female sex
  • gestational diabetes
  • mental illness
  • metabolic dysfunction-associated steatotic liver disease (previously nonalcoholic fatty liver disease)
  • suboptimal sleep
  • atrial fibrillation
完整详情

诊断性检查

首要检查

  • HbA1c
  • lipid profile
完整详情

需考虑的检查

  • B natriuretic peptide (BNP)/N-terminal prohormone B-natriuretic peptide (NT-proBNP)
  • transthoracic doppler echocardiogram
  • exercise ECG
  • exercise (stress) imaging test
  • pharmacologic (stress) imaging test
  • cardiac MRI or stress cardiac MRI
  • ankle-brachial index (ABI)
  • CT coronary angiography
  • CT coronary calcium scan
  • invasive coronary angiography
  • noncontrast head CT
  • brain MRI
  • duplex ultrasonography of carotid arteries
  • C-reactive protein
  • chest x-ray
完整详情

治疗流程

初步治疗

acute myocardial infarction or unstable angina

急症处理

highly significant coronary artery disease: without acute myocardial infarction or unstable angina

持续性治疗

diabetic cardiovascular disease: stable and/or after intervention

撰稿人

作者

Mohamed Al-Kazaz, MD

Assistant Professor of Medicine (Cardiology)

Section Chief, General Cardiology

Division of Cardiology, Department of Medicine

Northwestern University Feinberg School of Medicine

Bluhm Cardiovascular Institute

Northwestern Memorial Hospital

Chicago

IL

利益声明

MA has received research grants from Kiniksa Pharmaceuticals, Ventyx BioSciences, and Cardiol Therapeutics. He has also received speaking honoraria from Kiniksa Pharmaceuticals and consulting fees from Edwards Lifesciences.

鸣谢

Dr Mohamed Al-Kazaz would like to gratefully acknowledge Dr Alexander Meyer, Dr Laura Davidson, Dr Charles Davidson, and Dr Leonard E. Egede, the previous contributors to this topic, and would like to gratefully acknowledge the review by Dr Shreenidhi Venuraju, MB BS, MRCP, Wellington Hospital South, UK.

利益声明

AM, LD, CD, and LE declare that they have no competing interests. LEE is an author of a number of references cited in this topic. SV not disclosed.

同行评议者

Irfan Moinuddin, MD

Assistant Professor

Chicago Medical School

Rosalind Franklin University

Lombard

IL

利益声明

IM declares that he has no competing interests.

David Leehey, MD

Medical Director

Hines VA Hospital

Hines

IL

利益声明

DL declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Marx N, Federici M, Schütt K, et al. 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J. 2023 Oct 14;44(39):4043-140.全文  摘要

American Diabetes Association. Standards of care in diabetes - 2025. Diabetes Care. 2025 Jan 1;48(suppl 1):S14-352.全文

Joseph JJ, Deedwania P, Acharya T, et al. Comprehensive management of cardiovascular risk factors for adults with type 2 diabetes: a scientific statement from the American Heart Association. Circulation. 2022 Mar;145(9):e722-59.全文  摘要

Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018 May 15;71(19):e127-248.全文  摘要

Writing Committee Members; Lawton JS, Tamis-Holland JE, Bangalore S, et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. J Am Coll Cardiol. 2022 Jan 18;79(2):e21-129.全文  摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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