| Avtor/Urednik | Medvešček, Marko | |
| Naslov | Preprečevanje zapletov ateroskleroze pri bolnikih s sladkorno boleznijo - pregled prospektivnih študij | |
| Prevedeni naslov | Prevention of cardiovascular atherosclerotic complications in patients with diabetes - a survey of prospective intervention trials | |
| Tip | članek | |
| Vir | Med Razgl | |
| Vol. in št. | Letnik 40, št. Suppl 3 | |
| Leto izdaje | 2001 | |
| Obseg | str. 11-9 | |
| Jezik | slo | |
| Abstrakt | Diabetic macrovascular disease, including coronary, cerebrovascular and peripheral vascular disease, is a consequence of enhanced atherosclerosis, and represents the main pathology in type 2 diabetics. The disease is defined by elevated blood glucose above the threshold for diabetic microangiopathy, on which the antihyperglicemic intervention has a strong effect, but it has a very limited influence on diabetic macrovascular disease. However, the high cardiovascular risk in type 2 diabetes can be decreased by intervention on other risk factors, i. e. antihypertonic, antihypercholesterolemc; and antiagreggation therapy. These intervention therapies are at least as efficacious as in nondiabetics or even more so. The UK Prospective Diabetes Trial was the only study involving only type 2 diabetics that demonstrated a strong effect of antihyperglicemic therapy on microvascular complcations, and a strong effect of antihypertonic therapy on macrovascular complications, pointing to the fact, that blood glucose control is definitely not the only important theraputic factor in preventing diabetic cardiovascular complications. Post hoc study analysis in diabetic subgroups in secondary prevetion studies with inhibitors of HMG-CoA reduetase (statins) in coronary patients showed equal or greater reduction of coronary risk in diabetics compared to nondiabetics. Primary prevention studies on coronary risk reduction in type 2 diabetics are under way, involving statins and fibrates. Type 2 diabetics usually have at least one, and many more then one, modyfiable risk factor. Since life-style changes have very limited effect on risk factors, appropriate drugs must be used, and target values must be reached in order to diminish cardiovascular risk in patients with type 2 diabetes. | |
| Izvleček | Diabetična makroangiopatija je posledica ateroskleroze in je glavna patologija sladkorne bolezni tipa 2. Bolezen je sicer opredeljena z vrednostmi hiperglikemije, pri katerih se pojavi tveganje za mikroangiopatične zaplete. Dolgotrajna odlična urejenost glikemije lahko prepreči pojav ali napredovanje diabetične mikroangiopatije (retinopatije in nefropatije), zelo malo pa vpliva na pojavljanje koronarne bolezni, možganske kapi in periferne žilne bolezni. Veliko tveganje za makroangiopatijo, ki vodi v prizadetost srca in ožilja, lahko zmanjšamo z ukrepanjem zoper dejavnike tveganja, ki so sestavni del metaboličnega sidroma neodzivnosti na inzulin pri tipu 2 sladkorne bolezni. Intervencijske študije z antihipertoničnim, antihiperholesterolemičnim in antiagregacijskim zdravljenjem so dokazale enak ali večji učinek pri bolnikih s sladkorno boleznijo tipa 2 v primerjavi z bolniki brez nje. Študija UK Prospective Diabetes Study je edina dolgotrajna in obsežna študija, ki je vključevala samo bolnike s sladkorno boleznijo tipa 2 in je dokazala preprečljivost mikroangiopatičnih zapletov z intezivnim antihiperglikemičnim zdravljenjem, makroangiopatičnih pa z antihipertoničnim zdravljenjem. Naknadne analize študij o sekundarni preventivi bolezni srca in ožilja z zaviralci reduktaze HMG-CoA, ki so vključevale tudi bolnike s sladkorno boleznijo tipa 2, so dokazale zelo dober učinek pri sladkornih bolnikih s koronarno boleznijo. V teku so študije primarne preventive z zdravili, ki zmanjšujejo raven krvnih maščob, ki bodo osvetlile uporabnost zaviralcev reduktaze HMG-CoA in fibratov v primarni preventivi bolezni srca in žilja. Bolniki s sladkorno boleznijo tipa 2 imajo večinoma enega ali več dejavnikov tveganja, na katere moramo vplivati zaradi njihove velike srčnožilne ogroženosti. (Izvleček skrajšan pri 2000 znakih) | |
| Deskriptorji | DIABETIC ANGIOPATHIES HYPERLIPIDEMIA HYPERGLYCEMIA HYPERTENSION DIABETES MELLITUS, NON-INSULIN-DEPENDENT PLATELET AGGREGATION INHIBITORS |