[Cardiovascular risk reduction in the management of diabetic patients: what has changed since the '90s in the clinical approach?].

Abstract

Cardiovascular (CV) diseases are the main driver of morbidity and mortality in type 2 diabetes. Mitigating CV risk is therefore one of the main objectives when deciding which therapeutic strategy to adopt when treating diabetic patients. Several lines of evidence suggest nowadays that tight glucose control is associated with a significant reduction in CV risk only when implemented early in the course of the disease and obtained with minimal hypoglycemia risk. This is why glycemic targets "personalized" or "tailored" according to patient clinical characteristics are more and more advised by guidelines and scientific societies. Furthermore, hyperglycemia not only could directly induce vascular wall damage, but it might also act as a potential multiplier of the deleterious effects of all CV risk factors. Therefore, without treating to target all the coexistent risk factors, a CV risk reduction could hardly be achieved. Thus, when deciding which therapeutic strategy to adopt to treat hyperglycemia in diabetes, molecules should ideally be selected which do not worsen extra-glycemic risk factors (obesity, dyslipidemia, hypertension) or which, even better, could help mitigating them. Incretin-based therapies, and glucagon-like peptide-1 (GLP-1) receptor agonists in particular, seem to be able to induce weight loss, ameliorate lipid profile and reduce blood pressure. Furthermore, GLP-1 receptor agonist treatment is associated with a very low hypoglycemia risk. In theory, therefore, using this class of drugs for treating hyperglycemia should help mitigating CV risk in diabetes. Firm evidence of this is not so far available: however, should it convincingly emerge in the next future, it would definitely change our overall approach to CV risk in diabetes.

• Authors: Agostino Consoli, Patrizia Di Fulvio
• Journal: Giornale italiano di cardiologia (2006) (G Ital Cardiol (Rome)) Vol. 15 Issue 12 Suppl 2 Pg. 21S-26S (Dec 2014) ISSN: 1827-6806 [Print] Italy
• Vernacular Title: Ridurre il rischio cardiovascolare nel trattamento del paziente diabetico: cos'è cambiato dagli anni '90 ad oggi nell'approccio clinico?
• PMID: 25623547 (Publication Type: English Abstract, Journal Article)

Chemical References

• Blood Glucose
• Hypoglycemic Agents

Topics

• Blood Glucose (drug effects)
• Cardiovascular Diseases (etiology, prevention & control)
• Diabetes Mellitus, Type 2 (complications, drug therapy)
• Humans
• Hyperglycemia (complications, drug therapy)
• Hypoglycemia (chemically induced)
• Hypoglycemic Agents (adverse effects, pharmacology, therapeutic use)
• Practice Guidelines as Topic
• Precision Medicine
• Risk Factors