gabriele riccardi chair of endocrinology and metabolic diseases, federico ii university, naples,...
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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 PresentationTRANSCRIPT
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Gabriele RiccardiChair 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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Riccardi G et al, ATVB 1988
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Rosenson RS et al, Atherosclerosis 2011
Retinopathy predicts cardiovascular events in type 2 diabetes
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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
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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
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THE METASCREEN WRITING COMMITTEE* Diabetes Care, 2006
Prognostic value of the Metabolic Syndrome in diabetic patients
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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
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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
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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
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General features of the hyperglycaemia induced tissue damage
WV Brown, Am J Cardiol 2008
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AGEs PCK ROS
OssidoNitrico
Adesione LeucocitiCitochine
Chemochine
Proliferazione
Vasodilatazione
Migrazione
ALTERAZIONI DELLA FUNZIONE ENDOTELIALE INDOTTE DALL’IPERGLICEMIA
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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
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Adjusted hazard ratios (HR) for all-cause mortality by HbA1c deciles in people given oral hypoglycemic treatment
Currie CJ et al, Lancet 2010
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N Engl J Med 2008;358:2545-59
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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
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an aortic complicated atheromatous lesion with rupture of its fibreous cap
M= media, T= thrombus, LC=lipid core, FC= fibrous cap
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