Gabriele Riccardi Chair of Endocrinology and Metabolic Diseases, Federico II University, Naples,...
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Gabriele Riccardi Chair of Endocrinology and Metabolic Diseases, Federico II University, Naples, Italy Diabete e danno vascolare: il nesso fisiopatologico comune tra micro e macroangiopatia
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Diabete e danno vascolare: il nesso fisiopatologico comune tra micro e macroangiopatia. Gabriele Riccardi Chair of Endocrinology and Metabolic Diseases, Federico II University, Naples, Italy. Riccardi G et al, ATVB 1988. Retinopathy predicts cardiovascular events in type 2 diabetes. - PowerPoint PPT Presentation
Transcript of Gabriele Riccardi Chair of Endocrinology and Metabolic Diseases, Federico II University, Naples,...
Gabriele RiccardiChair of Endocrinology and Metabolic Diseases,
Federico II University, Naples, Italy
Diabete e danno vascolare: il nesso fisiopatologico comune tra micro e
macroangiopatia
Riccardi G et al, ATVB 1988
Rosenson RS et al, Atherosclerosis 2011
Retinopathy predicts cardiovascular events in type 2 diabetes
P.C.Y. Tong, Diabetic Medicine 2007
Multivariate-adjusted hazard ratio of CV events, renal events, all-cause mortality and composite events in Type 2 Diabetes in
relation to preexisting microangiopathy
Fattori di rischio per lo sviluppo delle complicanze croniche
Fattori genetici
Compenso glicemico insoddisfacente
Durata del diabete
Dislipidemia
Ipertensione arteriosa
Fumo di sigaretta
Sovrappeso
Sedentarietà
Infiammazione subclinica
THE METASCREEN WRITING COMMITTEE* Diabetes Care, 2006
Prognostic value of the Metabolic Syndrome in diabetic patients
UKPDS: Effect of Tight BP vs Tight Glucose Control on CV Events
Tight glucose control (FPG <6 mmol/L)
Tight BP control(BP <150/85 mm Hg)
% R
educ
tion
-50
-40
-30
-20
-10
0
MicrovascularOutcomes Stroke
Any Diabetes End Point Death
UKPDS Group, BMJ 1998
p< 0.05
p< 0.05
p< 0.05
p< 0.05
Fenofibrate reduces progression to microalbuminuria over 3 years in a placebo-controlled study in type 2 diabetes: results from the
Diabetes Atherosclerosis Intervention Study (DIAS).
Ansquer JC et al, Am J Kidney Dis 2005
Lifes
tyle
- Ge
netic
sInsulin-resistance
Hyperinsulinemia
Plateletaggregatio
nNO Glycemia
HDL-ColSmall LDL
Post prandial Triglyceri
de
SNS PAI-1
arterial wall
Muscle cell proliferatio
n O+
Proposed mechanisms linking insulin-resistance and/or hyperinsulinemia with atherosclerosis
General features of the hyperglycaemia induced tissue damage
WV Brown, Am J Cardiol 2008
AGEs PCK ROS
OssidoNitrico
Adesione LeucocitiCitochine
Chemochine
Proliferazione
Vasodilatazione
Migrazione
ALTERAZIONI DELLA FUNZIONE ENDOTELIALE INDOTTE DALL’IPERGLICEMIA
Incidence of complications in patients with type 2 diabetes by HbA1c- UKPDS
observational study
0
10
20
30
40
50
60
70
<6 6 to 7 7 to 8 8 to 9 9 to 10 >10
Inci
denc
e / 1
000
/ yea
r
MI (fatal + non fatal)Microvascular disease
HbA1c % BMJ 2000
Adjusted hazard ratios (HR) for all-cause mortality by HbA1c deciles in people given oral hypoglycemic treatment
Currie CJ et al, Lancet 2010
N Engl J Med 2008;358:2545-59
INTENSIVE STANDARD
Achieved median A1C (%)
6.4 7.5
Weight changes (kg)
+3.5 +0.4
Severe hypos (%) 16.2 5.1
On TZD at study end (%)
91 58
On insulin at study end (%)
77 55
THE ACCORD STUDY
an aortic complicated atheromatous lesion with rupture of its fibreous cap
M= media, T= thrombus, LC=lipid core, FC= fibrous cap
