Gabriele Riccardi Chair of Endocrinology and Metabolic Diseases,

Presentazione sul tema: "Gabriele Riccardi Chair of Endocrinology and Metabolic Diseases,"— Transcript della presentazione:

1 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

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3 Riccardi G et al, ATVB 1988

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

5 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

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 6

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

8 UKPDS: Effect of Tight BP vs Tight Glucose Control on CV Events
Any Diabetes End Point Microvascular Outcomes Stroke Death -10 -20 % Reduction p< 0.05 -30 p< 0.05 -40 p< 0.05 p< 0.05 -50 Tight glucose control (FPG <6 mmol/L) Tight BP control (BP <150/85 mm Hg) UKPDS Group, BMJ 1998

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

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

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

13 Incidence of complications in patients with type 2 diabetes by HbA1c- UKPDS observational study
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 THE ACCORD STUDY 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 77 55

17 M= media, T= thrombus, LC=lipid core, FC= fibrous cap
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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