Preprečevanje zapletov ateroskleroze pri bolnikih s sladkorno boleznijo - pregled prospektivnih študij = Prevention of cardiovascular atherosclerotic complications in patients with diabetes - a survey of prospective intervention trials
Medvešček, Marko
Diabetic macrovascular disease, including coronary, cerebrovascular and peripheral vascular disease, is a consequence of enhanced atherosclerosis, andrepresents the main pathology in type 2 ...diabetics. The disease is defined by elevated blood glucose above the threshold for diabetic microangiopathy, onwhich 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, modyfiablerisk 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.
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