ASCVD已成为2型糖尿病患者主要的致死因素，其进展受到多种因素的影响，包括血脂异常、氧化应激的加剧、蛋白质糖化作用的增强以及慢性炎症状态的持续。 糖尿病发生的风险与LDL-C的降低程度以及他汀类药物的使用存在直接的相关性[14]。但美国心脏病协会也指出[15]：他汀类药物可能会加快潜在糖尿病患者的病情进展，使其更快地发展为糖尿病。 而对于合并多种危险因素的群体，停用他汀会增加心血管疾病风险，因此在诊断出糖尿病前应继续使用他汀类药物。但他汀引起的糖尿病是否可逆，当前仍需继续研究。 但鉴于他汀类为糖尿病或糖尿病前期的发生的危险因素，基于我国当前国情，推荐这部分群体在血糖监测上[16,17]，可采用空腹血糖、75克葡萄糖耐量试验以及糖化血红蛋白作为联合筛查方法。若筛查结果均显示正常，则建议每三年进行一次复查。 参考文献：[1]Faubion SS, Kapoor E, Moyer AM, Hodis HN, Miller VM. Statin therapy: does sex matter? Menopause. 2019 Dec;26(12):1425-1435. [2]广东省药学会,广东省他汀类药物评价与遴选专家共识[J],今日药学,2022,32(7):481-489.[3]中华医学会心血管病学会,超高危动脉粥样硬化心血管疾病患者血脂管理中国专家共识[J],中华心血管病杂志,2020,48(4):280-286.[4]中国医师协会全科医师分会,2型糖尿病合并血脂异常的他汀类药物治疗专家共识[J],中华糖尿病杂志,2017,9(12):736-739.[5]Fracassi A, Marangoni M, Rosso P, Pallottini V, Fioramonti M, Siteni S, Segatto M. Statins and the Brain: More than Lipid Lowering Agents? Curr Neuropharmacol. 2019;17(1):59-83.[6]Wong ND, Zhao Y, Quek RGW, Blumenthal RS, Budoff MJ, Cushman M, Garg P, Sandfort V, Tsai M, Lopez JAG. Residual atherosclerotic cardiovascular disease risk in statin-treated adults: The Multi-Ethnic Study of Atherosclerosis. J Clin Lipidol. 2017 Sep-Oct;11(5):1223-1233.[7]Ngo-Metzger Q, Zuvekas S, Shafer P, Tracer H, Borsky AE, Bierman AS. Statin Use in the U.S. for Secondary Prevention of Cardiovascular Disease Remains Suboptimal. J Am Board Fam Med. 2019 Nov-Dec;32(6):807-817. [8]Razavi AC, Jain V, Grandhi GR, Patel P, Karagiannis A, Patel N, Dhindsa DS, Liu C, Desai SR, Almuwaqqat Z, Sun YV, Vaccarino V, Quyyumi AA, Sperling LS, Mehta A. Does Elevated High-Density Lipoprotein Cholesterol Protect Against Cardiovascular Disease? J Clin Endocrinol Metab. 2024 Jan 18;109(2):321-332. [9]Tomaszewski M, Stępień KM, Tomaszewska J, Czuczwar SJ. Statin-induced myopathies. Pharmacol Rep. 2011;63(4):859-66. [10]Dirks AJ, Jones KM. Statin-induced apoptosis and skeletal myopathy. Am J Physiol Cell Physiol. 2006 Dec;291(6):C1208-12. [11]Taylor BA, Thompson PD. Statin-Associated Muscle Disease: Advances in Diagnosis and Management. Neurotherapeutics. 2018 Oct;15(4):1006-1017. [12]Martirossian AN, Goldberg AC. Management of patients with statin intolerance. Best Pract Res Clin Endocrinol Metab. 2023 May;37(3):101714. [13]国家心血管病专家委员会心血管代谢医学专业委员会,他汀不耐受的临床诊断与处理中国专家共识[J],中国循环杂志,2024,39(2):105-115[14]Mansi IA, Chansard M, Lingvay I, Zhang S, Halm EA, Alvarez CA. Association of Statin Therapy Initiation With Diabetes Progression: A Retrospective Matched-Cohort Study. JAMA Intern Med. 2021 Dec 1;181(12):1562-1574. [15]Newman CB, Preiss D, Tobert JA, Jacobson TA, Page RL 2nd, Goldstein LB, Chin C, Tannock LR, Miller M, Raghuveer G, Duell PB, Brinton EA, Pollak A, Braun LT, Welty FK; American Heart Association Clinical Lipidology, Lipoprotein, Metabolism and Thrombosis Committee, a Joint Committee of the Council on Atherosclerosis, Thrombosis and Vascular Biology and Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; and Stroke Council. Statin Safety and Associated Adverse Events: A Scientific Statement From the American Heart Association. Arterioscler Thromb Vasc Biol. 2019 Feb;39(2):e38-e81.[15]中华医学会内分泌学分会,中国成人糖尿病前期干预的专家共识(2023年)[J],中华糖尿病杂志,2023,15(6):484-494[16]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2020年版)[J].中华糖尿病杂志,2021,13(4):315-409. 责任编辑：医学界心血管频道责任编辑：卡带 *"医学界"力求所发表内容专业、可靠，但不对内容的准确性做出承诺；请相关各方在采用或以此作为决策依据时另行核查。
