Page 176 - fbkCardioDiabetes_2017

152 DKD is Coronary Equivalent (Evidence And Remedy)

class strongly suggests a class effect toward protec- lar disease in Type 1 (insulin-dependent) diabetic subjects with and with-
tion against DKD. The mechanisms of action may be out diabetic nephropathy in Finland. Diabetelogia. 1998;41(7):784-90.
multifactorial from lower levels of glycemia and body 5. Charles.T, The Risk of Cardiovascular Disease Mortality Associated with
weight to direct effects on the kidney.This has abear- Microalbuminuria and Gross Proteinuria in Persons with older onset DM.
ing on CV outcomes also. Arch.of Int.Med 2000 : 160 (8) 1093-1100
6. Stehouwer CD, Smulders YM. Microalbuminuria and risk for cardio-
SGLT 2 inhibitors and Cardio Renoprotection: The vascular disease: analysis of potential mechanisms. J Am Soc Nephrol.
available SGLT2 inhibitors are Canagliflozin, Dapagli- 2006;17(8):2106-111.
flozin and Empagliflozin.The Empaglifozin Cardio- 7. Jefferson JA, Shankland SJ, Pichler RH. Proteinuria in diabetic kidney dis-
vascular Outcomes, and Mortality in Type 2 Diabe- ease: a mechanistic viewpoint. Kidney Int. 2008;74(1):22-36.
tes Clinical Trial (EMPA REG Study) recently showed 8. Bigazzi R, Bianchi S, Nenci R, et al. Increased thickness of the carotid
48
that empaglifozin significantly lowered rates of death artery in patients with essential hypertension and microalbuminuria. J
from CV causes (38% relative risk reduction), hospi- Hum Hypertens.1995;9(10):827-33.
talization for heart failure (35% relative risk reduction), 9. Diamond JR. Analogous pathobiologic mechanisms in glomerulosclerosis
and death from any cause (32% relative risk reduc- and atherosclerosis. Kidney Int. 1991;31 (Suppl):S29-34.
tion) in patients with T2DM and CV already receiving 10. American Diabetes Association. Standards of medical care in diabe-
standard of care for treatment of BP and lipids. CVOT tes—2008. Diabetes Care. 2008;31(Suppl 1): S12–S54.
data with canagliflozin as reported in CANVAS study 11. Berry C, Tardif JC, Bourassa MG. Coronary heart disease in patients with
has also shown similar CV outcome benefits. diabetes: Part I: recent advances in prevention and noninvasive manage-
ment. J Am Coll Cardiol. 2007;49(6):631-42.
In a nutshell: 12. Stratton IM, Adler AI, Neil HA, et al. Association of glycemia with macro-
• A very high cardiac risk exists in patients with di- vascular and microvascular complications of type 2 diabetes (UKPDS 35):
prospective observational study. BMJ. 2000;321(7258):405-12.
abetic nephropathy (DN). This risk starts very early
in the course of DN 13. American Diabetes Association. Standards of medical care in diabe-
• Albuminuria and reduced eGFR are continuous risk tes-2008. Diabetes Care. 2008;31(Suppl 1):S12-54.
factors for cardiovascular and kidney outcomes in 14. Action to Control Cardiovascular Risk in Diabetes Study Group. Ef-
patients with T2DM that are independent of each fects of intensive glucose lowering in type 2 diabetes. N Engl J Med.
2008;358(24):2545-59.
other and of other known risk factors
• The non-traditional and DKD related risk factors 15. Berry C, Tardif JC, Bourassa MG. Coronary heart disease in patients with
diabetes: Part I: recent advances in prevention and noninvasive manage-
like insulin resistance, endothelial dysfunction, ment. J Am Coll Cardiol. 2007;49(6):631-42.
plasminogen activator inhibitor, C-reactive protein,
adhesion molecules, hyperhomocysteinemia and 16. Stratton IM, Adler AI, Neil HA, et al. Association of glycemia with macro-
vascular and microvascular complications of type 2 diabetes (UKPDS 35):
vascular wall abnormalities also play a contribu- prospective observational study. BMJ. 2000;321(7258):405-12.
tory role
• Metformin and Pioglitazone have been more wide- 17. Fonseca VA. Rationale for the use of insulin sensitizers to prevent cardio-
vascular events in type 2 diabetes mellitus. Am J Med. 2007;120(Suppl
ly investigated with regard to cardiovascular end 2):S18-25.
points, with several large randomized trails show- 18. Dandona P, Chaudhuri A, Ghanim H, et al. Proinflammatory effects of
ing beneficial effects on cardiovascular outcomes glucose and anti-inflammatory effect of insulin: relevance to cardiovascular
• Blood pressure control use of statins and other life disease. Am J Cardiol. 2007;99(4A):15B-26B.
style changes have shown definite CV outcome 19. Muntner P, He J, Chen J, et al. Prevalence of non-traditional cardiovascular
benefits. disease risk factors among persons with impaired fasting glucose, impaired
• Newer drugs for diabetes offer promise towards glucose tolerance, diabetes, and the metabolic syndrome: Analysis of the
cardio Renal protection and long term studies and Third National Health and Nutrition Examination Survey (NHANES III).
Ann Epidemiol. 2004;14:686-95.
experience should help us to improve the outcome.
20. Sobel BE. Optimizing cardiovascular outcomes in diabetes mellitus. Am J
References Med. 2007;120(Suppl 2):S3-S11.
1. Grundy SM, Benjamin IJ, Burke GL, et al. Diabetes and cardiovascular 21. UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive
disease: a statement for healthcare professionals from the American Heart blood-glucose control with metformin on complications in overweight pa-
Association. Circulation. 1999;100(10):1134-46. tients with type 2 diabetes (UKPDS) [published correction appears in
Lancet. 1998;352(9131):854-65.
2. Dunn EJ, Grant PJ. Type 2 diabetes: an atherothrombotic syndrome. Curr
Mol Med. 2005;5(3):323-32. 22. Action to Control Cardiovascular Risk in Diabetes Study Group. Ef-
fects of intensive glucose lowering in type 2 diabetes. N Engl J Med.
3. Kannel WB, MacGee DL. Diabetes and glucose tolerance as risk fac- 2008;358(24):2545-59.
tors for cardiovascular disease: the Framingham study. Diabetes Care.
1979;2(2):120-6. 23. Mazzone T. Prevention of macrovascular disease in patients with diabe-
tes mellitus: Opportunities for intervention. Am J Med. 2007;120(Suppl
4. Tuomilehto J, Borch-Johnsen K, Molarius A, et al. Incidence of cardiovascu- 2):S26-32.

GCDC 2017