<International Circulation> : Can you give us your views on how can best conduct treatment to reduce the burden of vascular disease in diabetes? Diabetes is a growing problem in China so many clinicians are very interested in this topic.
 

  《国际循环》：Chalmers教授，您认为高血压合并糖尿病最佳的治疗措施有哪些？对于我们或临床医生来说，降低糖尿病患者心血管疾病发生率最关键或最重要什么？特别是在中国，糖尿病患者迅速增加，许多临床医生都对这一领域很感兴趣，对此你有何见解？

    Professor Chalmers : The most important thing is that diabetes is a disorder with multiple risk factors. It is very common to have not just diabetes but many other risk factors such as obesity， lipid disorders， and elevated blood pressure. Therefore， I think the most important thing is to address this as a multifactorial treatment problem because there is high absolute risk with multiple risk factors. Of those risks and of the treatments available probably the single most important one to reduce cardiovascular morbidity and mortality， which is the largest single risk factor for death and disorders in diabetic patients， is blood pressure lowering. Thus， I think that is the most important thing. Obviously， glucose lowering is terribly important and is probably as fundamental but not so much for cardiovascular risk reduction as it is for metabolic control and it is absolutely essential to achieve good metabolic control. I believe it also has some benefit in cardiovascular protection but not as dramatic or important as blood pressure. The third and also very important factor is lipids. Reducing cholesterol and addressing lipids is very important. It is also important to think of aspirin. Here the evidence is very strong for people with established vascular disease and diabetes but not nearly as compelling for people with diabetes who do not yet have established vascular disease. I would say that blood pressure lowering remains the single most important thing for cardiovascular protection， along with cholesterol control， lipid lowering， aspirin， and glucose control as well. I am not denigrating glucose control because for metabolic and microvascular protection it is still very important.

    Chalmers教授：糖尿病是多种危险因素导致的代谢紊乱，通常患者除了糖尿病外还有许多危险因素：过重，血脂异常，血压升高等。我认为最重要是对这些危险因素进行防治，因为多种危险因素意味着高绝对风险。导致糖尿病患者死亡和残疾最主要的危险因素是心血管疾病及其致死率，而其治疗措施中最关键的是降低血压。很显然，我认为这是糖尿病患者治疗措施中最重要的。降低血糖是第二重要的治疗措施，因为降低血糖作为基本目标，虽然没有减少心血管疾病重要，但其涉及代谢调控，因此控制血糖可以获得良好的代谢调节。我也相信保护心血管的益处不如降压重要或明显。血脂异常是第三个重要的危险因素，因此我认为降低胆固醇和血脂在治疗中排第三位，也很重要。我认为阿司匹林也非常重要，有证据表明，对于糖尿病合并心血管疾病患者而非新近确诊的糖尿病给予阿司匹林治疗后未并发心血管病，但其原因尚未阐明。但是除了心血管的保护，降低胆固醇和血脂，阿司匹林及控制血糖，降低血压仍是最重要的，这并不是贬低控制血糖的重要性，因为降低血糖对于代谢和微血管的保护作用仍是非常重要。

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