Diabete e danno vascolare il nesso fisiopatologico comune
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 Rosenson RS et al, Atherosclerosis 2011
Multivariate-adjusted hazard ratio of CV events, renal events, all-cause mortality and composite events in Type 2 Diabetes in relation to preexisting microangiopathy P. C. Y. Tong, Diabetic Medicine 2007
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
Prognostic value of the Metabolic Syndrome in diabetic patients THE METASCREEN WRITING COMMITTEE* Diabetes Care, 2006
UKPDS: Effect of Tight BP vs Tight Glucose Control on CV Events 0 Stroke Any Diabetes End Point Microvascular Outcomes Death % Reduction -10 -20 p< 0. 05 -30 p< 0. 05 -40 -50 p< 0. 05 Tight glucose control (FPG <6 mmol/L) Tight BP control (BP <150/85 mm Hg) UKPDS Group, BMJ 1998
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
Proposed mechanisms linking insulin-resistance and/or hyperinsulinemia with atherosclerosis Insulin-resistance Lifestyle - Genetics Platelet aggregation NO Glycemia HDL-Col Small LDL Post prandial Triglyceride arterial wall Muscle cell proliferation O+ SNS Hyperinsulinemia PAI-1
General features of the hyperglycaemia induced tissue damage WV Brown, Am J Cardiol 2008
Adesione Leucociti Citochine Chemochine AGEs PCK ROS Ossido Nitrico Vasodilatazione Proliferazione Migrazione ALTERAZIONI DELLA FUNZIONE ENDOTELIALE INDOTTE DALL’IPERGLICEMIA
Incidence of complications in patients with type 2 diabetes by Hb. A 1 c- UKPDS observational study Hb. A 1 c % BMJ 2000
Adjusted hazard ratios (HR) for all-cause mortality by Hb. A 1 c deciles in people given oral hypoglycemic treatment Currie CJ et al, Lancet 2010
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THE ACCORD STUDY INTENSIVE STANDARD Achieved median A 1 C (%) 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 77 end (%) 55
an aortic complicated atheromatous lesion with rupture of its fibreous cap M= media, T= thrombus, LC=lipid
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