La presentazione è in caricamento. Aspetta per favore

La presentazione è in caricamento. Aspetta per favore

Gabriele Riccardi Chair of Endocrinology and Metabolic Diseases, Federico II University, Naples, Italy Diabete e danno vascolare: il nesso fisiopatologico.

Presentazioni simili


Presentazione sul tema: "Gabriele Riccardi Chair of Endocrinology and Metabolic Diseases, Federico II University, Naples, Italy Diabete e danno vascolare: il nesso fisiopatologico."— Transcript della presentazione:

1 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

2

3 Riccardi G et al, ATVB 1988

4 Rosenson RS et al, Atherosclerosis 2011 Retinopathy predicts cardiovascular events in type 2 diabetes

5 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

6 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

7 THE METASCREEN WRITING COMMITTEE* Diabetes Care, 2006 Prognostic value of the Metabolic Syndrome in diabetic patients

8 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) % Reduction Microvascular Outcomes Stroke Any Diabetes End Point Death UKPDS Group, BMJ 1998 p< 0.05

9 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

10 Lifestyle - Genetics Insulin-resistance Hyperinsulinemia Platelet aggregation NO Glycemia HDL-Col Small LDL Post prandial Triglyceride SNS PAI-1 arterial wall Muscle cell proliferation O+O+ Proposed mechanisms linking insulin-resistance and/or hyperinsulinemia with atherosclerosis

11 General features of the hyperglycaemia induced tissue damage WV Brown, Am J Cardiol 2008

12 AGEs PCK ROS Ossido Nitrico Adesione Leucociti Citochine Chemochine Proliferazione Vasodilatazione Migrazione ALTERAZIONI DELLA FUNZIONE ENDOTELIALE INDOTTE DALLIPERGLICEMIA

13 Incidence of complications in patients with type 2 diabetes by HbA1c- UKPDS observational study HbA1c % BMJ 2000

14 Adjusted hazard ratios (HR) for all-cause mortality by HbA1c deciles in people given oral hypoglycemic treatment Currie CJ et al, Lancet 2010

15 N Engl J Med 2008;358:

16 INTENSIVESTANDARD Achieved median A1C (%) Weight changes (kg) Severe hypos (%) On TZD at study end (%) 9158 On insulin at study end (%) 7755 THE ACCORD STUDY

17 an aortic complicated atheromatous lesion with rupture of its fibreous cap M = media, T= thrombus, LC=lipid core, FC= fibrous cap

18

19

20


Scaricare ppt "Gabriele Riccardi Chair of Endocrinology and Metabolic Diseases, Federico II University, Naples, Italy Diabete e danno vascolare: il nesso fisiopatologico."

Presentazioni simili


Annunci Google